Provider Demographics
NPI:1760904932
Name:IDEAL SPECIALTY PHARMACY, LLC
Entity Type:Organization
Organization Name:IDEAL SPECIALTY PHARMACY, LLC
Other - Org Name:PROFESSIONAL PHARMACY PLUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-809-0984
Mailing Address - Street 1:400 W ARBROOK BLVD STE 111
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-3175
Mailing Address - Country:US
Mailing Address - Phone:972-809-0984
Mailing Address - Fax:972-809-0986
Practice Address - Street 1:400 W ARBROOK BLVD STE 111
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-3175
Practice Address - Country:US
Practice Address - Phone:972-809-0984
Practice Address - Fax:972-809-0986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX314603336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX31460OtherSTATE LIC
TX5921665OtherNCPDP
TX5921665OtherNCPDP