Provider Demographics
NPI:1215702956
Name:POLARIS SPECIALTY PHARMACY, LLC
Entity type:Organization
Organization Name:POLARIS SPECIALTY PHARMACY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CORPORATE DIRECTOR OF COMPLIANCE CO
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-589-9747
Mailing Address - Street 1:2900 NW 60TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-1774
Mailing Address - Country:US
Mailing Address - Phone:800-589-9747
Mailing Address - Fax:954-923-9261
Practice Address - Street 1:1010 E ARROW HWY
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-1020
Practice Address - Country:US
Practice Address - Phone:626-209-8169
Practice Address - Fax:800-781-3364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-22
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy