Provider Demographics
NPI:1568859122
Name:AMERICAN SPECIALTY PHARMACY INC
Entity type:Organization
Organization Name:AMERICAN SPECIALTY PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT/AO
Authorized Official - Prefix:
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMEED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-919-2520
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
Mailing Address - Country:US
Mailing Address - Phone:214-919-2520
Mailing Address - Fax:214-919-2524
Practice Address - Street 1:1300 3RD ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2208
Practice Address - Country:US
Practice Address - Phone:361-221-4778
Practice Address - Fax:361-237-1748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-22
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336S0011X
TX298043336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX467198Medicaid
2151502OtherPK