Provider Demographics
NPI:1053961854
Name:986 SPECIALTY PHARMACY 3 INC
Entity type:Organization
Organization Name:986 SPECIALTY PHARMACY 3 INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MISS
Authorized Official - First Name:ADINA
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:469-543-0199
Mailing Address - Street 1:6205 COIT RD STE 356
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-5491
Mailing Address - Country:US
Mailing Address - Phone:469-543-0199
Mailing Address - Fax:469-543-0194
Practice Address - Street 1:6205 COIT RD STE 356
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-5491
Practice Address - Country:US
Practice Address - Phone:469-543-0199
Practice Address - Fax:469-543-0194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-13
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150132Medicaid