Provider Demographics
NPI:1104269620
Name:COLUMBIA SPECIALTY INVESTMENT, LLC
Entity type:Organization
Organization Name:COLUMBIA SPECIALTY INVESTMENT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RITESH
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-933-8965
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 1:5500 KNOLL NORTH DR STE 140
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2360
Practice Address - Country:US
Practice Address - Phone:410-964-5500
Practice Address - Fax:410-964-5511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-15
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MDP066613336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2143682-00Medicaid
2150645OtherPK