Provider Demographics
NPI:1255389961
Name:SPECIALTY PHARMACIES, INC.
Entity type:Organization
Organization Name:SPECIALTY PHARMACIES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:1120 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2044
Mailing Address - Country:US
Mailing Address - Phone:206-624-1391
Mailing Address - Fax:206-624-1791
Practice Address - Street 1:1120 CHERRY ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2044
Practice Address - Country:US
Practice Address - Phone:206-624-1391
Practice Address - Fax:206-624-1791
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
WACF00058164333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPHAR.CF.00058164OtherSTATE LICENSE
4929595OtherNCPDP PROVIDER ID
WA6025514Medicaid
WA6025514Medicaid
WAPHAR.CF.00058164OtherSTATE LICENSE