Provider Demographics
NPI:1770035149
Name:TEXAS SPECIALTY GROUP LLC
Entity Type:Organization
Organization Name:TEXAS SPECIALTY GROUP LLC
Other - Org Name:SOUTHSIDE PHARMACY 12
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HARISH
Authorized Official - Middle Name:
Authorized Official - Last Name:KATHARANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-660-8888
Mailing Address - Street 1:18648 MCKAY DR STE 110
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-5724
Mailing Address - Country:US
Mailing Address - Phone:832-831-7707
Mailing Address - Fax:832-831-7708
Practice Address - Street 1:18648 MCKAY DR STE 110
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-5724
Practice Address - Country:US
Practice Address - Phone:832-831-7707
Practice Address - Fax:832-831-7708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-01
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX311243336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2166204OtherPK