Provider Demographics
NPI:1902273980
Name:INFINITY PHARMACY, LLC
Entity Type:Organization
Organization Name:INFINITY PHARMACY, LLC
Other - Org Name:IPS SPECIALTY, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:SMOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-765-5457
Mailing Address - Street 1:3313 ESSEX DR STE 200
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-9714
Mailing Address - Country:US
Mailing Address - Phone:214-765-5470
Mailing Address - Fax:214-765-5466
Practice Address - Street 1:3313 ESSEX DR STE 100
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-9714
Practice Address - Country:US
Practice Address - Phone:214-765-5470
Practice Address - Fax:214-765-5466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-26
Last Update Date:2019-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX301593336C0003X, 3336S0011X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2150058OtherPK
TX149726Medicaid