Provider Demographics
NPI:1912503194
Name:IRIDIUM SPECIALTY PHARMACY, PLLC
Entity Type:Organization
Organization Name:IRIDIUM SPECIALTY PHARMACY, PLLC
Other - Org Name:IRIDIUM SPECIALTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DELSHALONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:INGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:713-324-7235
Mailing Address - Street 1:2240 NAVIGATION BLVD STE 200B
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77003-1564
Mailing Address - Country:US
Mailing Address - Phone:713-324-7235
Mailing Address - Fax:713-324-7236
Practice Address - Street 1:2240 NAVIGATION BLVD STE 200B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77003-1577
Practice Address - Country:US
Practice Address - Phone:713-324-7235
Practice Address - Fax:713-324-7236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-11
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No251E00000XAgenciesHome Health
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX33541OtherTEXAS STATE BOARD OF PHARMACY - PHARMACIST LICENSE