Organization
SPECIALTY PHARMA SAI INC
Active
Other names
Mkt Specialty Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
VIJAYA LAXMI (PRESIDENT)
(949) 590-0056
Entity
Organization
Contact information
Practice address
4153B UNIVERSITY AVE, SUITE B, SAN DIEGO, CA 92105-1421
(949) 590-0056
(619) 333-2525
Mailing address
15642 SAND CANYON AVE UNIT 53871, IRVINE, CA 92619-5430
(949) 590-0056
(619) 333-2525
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1386226306
—
CA
01
—
5674812
NCPDP
—
01
—
PHY58096
CALIFORNIA BOARD OF PHARMACY
CA
Enumeration date
04/28/2021
Last updated
04/29/2022
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