Provider Demographics
NPI:1013070572
Name:SPS SPECIALTY PHARMACY SERVICES INC
Entity Type:Organization
Organization Name:SPS SPECIALTY PHARMACY SERVICES INC
Other - Org Name:SPS SPECIALTY PHARMACY SERVICES INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ENID
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:787-704-2025
Mailing Address - Street 1:75 AVE LUIS MUNOZ MARIN
Mailing Address - Street 2:75 LUIS MUNOZ MARIN PLAZA NOTRE DAME
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-3856
Mailing Address - Country:US
Mailing Address - Phone:787-704-2025
Mailing Address - Fax:787-704-2027
Practice Address - Street 1:75 AVE LUIS MUNOZ MARIN
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-3856
Practice Address - Country:US
Practice Address - Phone:787-704-2025
Practice Address - Fax:787-704-2027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 261QI0500X, 332B00000X, 333600000X, 3336C0003X, 3336C0004X, 3336H0001X
PR17-F-31743336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No251E00000XAgenciesHome Health
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2087538OtherPK
5846350001Medicare NSC