Provider Demographics
NPI:1043822620
Name:SPECIALTYCARERX LLC
Entity type:Organization
Organization Name:SPECIALTYCARERX LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GOULDING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-459-6514
Mailing Address - Street 1:821 N US HIGHWAY 1 STE A
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-4528
Mailing Address - Country:US
Mailing Address - Phone:631-459-6514
Mailing Address - Fax:877-503-7230
Practice Address - Street 1:821 N US HIGHWAY 1 STE A
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-4528
Practice Address - Country:US
Practice Address - Phone:631-459-6514
Practice Address - Fax:877-503-7230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-17
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy