Provider Demographics
NPI:1487488664
Name:PANTHERX SPECIALTY LLC
Entity type:Organization
Organization Name:PANTHERX SPECIALTY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTRACTS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-726-8479
Mailing Address - Street 1:121 BAYER RD BLDG 5
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15205-9706
Mailing Address - Country:US
Mailing Address - Phone:855-726-8479
Mailing Address - Fax:855-246-3986
Practice Address - Street 1:280 MOORE LANE
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017
Practice Address - Country:US
Practice Address - Phone:855-726-8479
Practice Address - Fax:855-246-3986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-29
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1487488664Medicaid
SD1487488664Medicaid
HI1487488664Medicaid
VT6718462Medicaid
ME1487488664Medicaid
IN300100596Medicaid
VA30015069640005Medicaid
CO9000238468Medicaid
NC1487488664Medicaid
OK200566670CMedicaid
PA102702417-0004Medicaid
KY7101025040Medicaid
TNQ097581Medicaid
WI100296778Medicaid
NH3147472Medicaid
OH0079597Medicaid
AZ177060Medicaid