Provider Demographics
NPI:1700358389
Name:TITAN SPECIALTY PHARMACY
Entity Type:Organization
Organization Name:TITAN SPECIALTY PHARMACY
Other - Org Name:TITIAN RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMIN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:MAJA
Authorized Official - Middle Name:CALVANISE
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-732-3280
Mailing Address - Street 1:8360 LBJ FWY STE 230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-1130
Mailing Address - Country:US
Mailing Address - Phone:214-478-8564
Mailing Address - Fax:
Practice Address - Street 1:8360 LBJ FWY STE 215
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-1222
Practice Address - Country:US
Practice Address - Phone:214-478-8564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TITAN RX
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-20
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy