RELIANCE SPECIALTY INFUSION, LLC - NPI NUMBER 1417208679

Summary

Provider Name: RELIANCE SPECIALTY INFUSION, LLC

NPI Number: 1417208679

Clasification: Pharmacy (3336S0011X)

Specialization: Specialty Pharmacy

Address:
2920 E MOHAWK LN
SUITE 114
PHOENIX, AZ
ZIP 85050

Phone Number: (602) 821-8218



Detailed Information

RELIANCE SPECIALTY INFUSION, LLC is a specialty pharmacy pharmacy in Phoenix, AZ. The provider is a pharmacy that dispenses generally low volume and high cost medicinal preparations to patients who are undergoing intensive therapies for illnesses that are generally chronic, complex and potentially life threatening. Often these therapies require specialized delivery and administration. The assigned NPI number for this provider is 1417208679 and is registered as an organization entity type.

The provider's business address is:

2920 E MOHAWK LN
SUITE 114
PHOENIX, AZ
ZIP 85050-772
Phone: (602) 821-8218

The provider's authorized official is Laura Gravina .
The authorized official title is Ceo and has the following contact phone number (602) 821-8218.

The enumeration date for this NPI number is 9/27/2012 and was last updated on 9/27/2012.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 3336S0011X Pharmacy Specialty Pharmacy Y005540 AZ Yes

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1417208679 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name RELIANCE SPECIALTY INFUSION, LLC The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider First Line Business Practice Location Address 2920 E MOHAWK LN The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
6 Provider Second Line Business Practice Location Address SUITE 114 The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
7 Provider Business Practice Location Address City Name PHOENIX The city name in the location address of the provider being identified.
8 Provider Business Practice Location Address State Name AZ The State code in the location of the provider being identified.
9 Provider Business Practice Location Address Postal Code 850504772 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
10 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
11 Provider Business Practice Location Address Telephone Number 6028218218 The telephone number associated with the location address of the provider being identified.
12 Provider Enumeration Date 9/27/2012 The date the provider was assigned a unique identifier (assigned an NPI).
13 Last Update Date 9/27/2012 The date that a record was last updated or changed.
14 Authorized Official Last Name GRAVINA The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
15 Authorized Official First Name LAURA The first name of the authorized official.
16 Authorized Official Title or Position CEO The title or position of the authorized official.
17 Authorized Official Telephone Number 6028218218 The 10-position telephone number of the authorized official.
18 Healthcare Provider Taxonomy Code 1 3336S0011X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
19 Provider License Number 1 Y005540 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
20 Provider License Number State Code 1 AZ The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
21 Healthcare Provider Primary Taxonomy Switch 1 Y
22 Is Organization Subpart N
23 Authorized Official Name Prefix Text MISS
24 Authorized Official Credential Text CEO

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This page was last updated on: 3/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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