Provider Demographics
NPI:1699816892
Name:PRESCRIPTION SPECIALTIES, INC.
Entity Type:Organization
Organization Name:PRESCRIPTION SPECIALTIES, INC.
Other - Org Name:THE COMPOUNDING SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARM.D.
Authorized Official - Prefix:MR
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:BRANDON
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-870-3150
Mailing Address - Street 1:3349 INDEPENDENCE DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-8310
Mailing Address - Country:US
Mailing Address - Phone:205-870-3150
Mailing Address - Fax:855-862-0446
Practice Address - Street 1:3349 INDEPENDENCE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-8310
Practice Address - Country:US
Practice Address - Phone:205-870-3150
Practice Address - Fax:855-862-0446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1106933336C0003X
3336C0004X, 3336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL189716Medicaid