Provider Demographics
NPI:1962502203
Name:MAXOR NATIONAL PHARMACY SERVICES LLC
Entity Type:Organization
Organization Name:MAXOR NATIONAL PHARMACY SERVICES LLC
Other - Org Name:MAXOR SPECIALTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. DIR. PHARMACY PAYOR CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ATKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-242-7782
Mailing Address - Street 1:320 S POLK ST STE 800
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79101-1429
Mailing Address - Country:US
Mailing Address - Phone:806-242-7782
Mailing Address - Fax:806-553-7383
Practice Address - Street 1:102 SW 3RD AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79101-1443
Practice Address - Country:US
Practice Address - Phone:806-355-5029
Practice Address - Fax:806-553-7383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BP3500X, 333600000X, 3336C0003X, 3336S0011X
TX165593336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX321011Medicaid
2100570OtherPK
TX321011Medicaid