Provider Demographics
NPI:1649653874
Name:AMERICAN SPECIALTY PHARMACY INC
Entity type:Organization
Organization Name:AMERICAN SPECIALTY PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMEED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-218-1641
Mailing Address - Street 1:13988 DIPLOMAT DR
Mailing Address - Street 2:STE 100
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75234-8807
Mailing Address - Country:US
Mailing Address - Phone:214-919-2520
Mailing Address - Fax:214-919-2524
Practice Address - Street 1:501 S RANCHO DR UNIT G
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4828
Practice Address - Country:US
Practice Address - Phone:702-912-4844
Practice Address - Fax:702-912-4846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-07
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NVPH033473336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1649653874Medicaid
2152926OtherPK
6644460005Medicare NSC