Provider Demographics
NPI:1457532590
Name:SPECIALTY PHARMACIES, INC.
Entity Type:Organization
Organization Name:SPECIALTY PHARMACIES, INC.
Other - Org Name:2ND 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 1:45 MELVILLE PARK RD
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-3109
Mailing Address - Country:US
Mailing Address - Phone:631-547-6531
Mailing Address - Fax:631-547-6532
Practice Address - Street 1:465 2ND ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-3839
Practice Address - Country:US
Practice Address - Phone:510-835-0774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALLION HEALTHCARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5628803OtherNCPDP
CAPHY 50166OtherSTATE LICENSE
CAPHA 50166Medicaid
CAPHA 50166Medicaid