Provider Demographics
NPI:1538544937
Name:DALLAS SPECIALTY PHARMACY,LLC
Entity type:Organization
Organization Name:DALLAS SPECIALTY PHARMACY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING CONTACT
Authorized Official - Prefix:MR
Authorized Official - First Name:NIZAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALIKHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-235-5895
Mailing Address - Street 1:5501 GORDON SMITH
Mailing Address - Street 2:SUITE 170
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75089
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5501 GORDON SMITH
Practice Address - Street 2:SUITE 170
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75089
Practice Address - Country:US
Practice Address - Phone:240-235-5895
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX300793336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy