Provider Demographics
NPI:1306882774
Name:SPECIALIZED PHARMACY, INC.
Entity type:Organization
Organization Name:SPECIALIZED PHARMACY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-987-8500
Mailing Address - Street 1:15401 VANTAGE PKWY W
Mailing Address - Street 2:SUITE 120
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77032-1968
Mailing Address - Country:US
Mailing Address - Phone:281-987-8500
Mailing Address - Fax:281-987-2660
Practice Address - Street 1:15401 VANTAGE PKWY W
Practice Address - Street 2:SUITE 120
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77032-1968
Practice Address - Country:US
Practice Address - Phone:281-987-8500
Practice Address - Fax:281-987-2660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18791333600000X
3336M0002X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144678Medicaid
4593895OtherOTHER ID NUMBER-COMMERCIAL NUMBER