Provider Demographics
NPI:1891796447
Name:SPECIALTY INFUSION PHARMACY INC.
Entity Type:Organization
Organization Name:SPECIALTY INFUSION PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-773-7376
Mailing Address - Street 1:250 TECHNOLOGY PARK
Mailing Address - Street 2:LEGAL DEPT
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-7115
Mailing Address - Country:US
Mailing Address - Phone:407-804-6700
Mailing Address - Fax:407-804-5647
Practice Address - Street 1:9568 ARCHIBALD AVE
Practice Address - Street 2:SUITE A
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5710
Practice Address - Country:US
Practice Address - Phone:800-331-2060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY44017333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA466270Medicaid
FL4976800001Medicare ID - Type Unspecified