Provider Demographics
NPI:1932922325
Name:EL PASO SPECIALTY INVESTMENT LLC
Entity type:Organization
Organization Name:EL PASO SPECIALTY INVESTMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAUSRATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-302-6555
Mailing Address - Street 1:1400 GEORGE DIETER DR STE 180
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-7656
Mailing Address - Country:US
Mailing Address - Phone:915-302-6555
Mailing Address - Fax:915-302-3434
Practice Address - Street 1:1400 GEORGE DIETER DR STE 180
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7656
Practice Address - Country:US
Practice Address - Phone:915-302-6555
Practice Address - Fax:915-302-3434
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EL PASO SPECIALTY INVESTMENT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy