Provider Demographics
NPI:1972551687
Name:SPECIALTY PHARMACIES, INC.
Entity Type:Organization
Organization Name:SPECIALTY PHARMACIES, INC.
Other - Org Name:CASTRO STREET PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT AND TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:J
Authorized Official - Last Name:FICHERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-297-1018
Mailing Address - Street 1:191 GOLDEN GATE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-3809
Mailing Address - Country:US
Mailing Address - Phone:415-255-0516
Mailing Address - Fax:415-255-0937
Practice Address - Street 1:191 GOLDEN GATE AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-3809
Practice Address - Country:US
Practice Address - Phone:415-255-0516
Practice Address - Fax:415-255-0937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 50167333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0585464OtherNCPDP PROVIDER ID
CAPHA 50167Medicaid
CAPHY 50167OtherSTATE LICENSE
CAPHY 50167OtherSTATE LICENSE