Provider Demographics
NPI:1922368257
Name:TEXAS SPECIALTY GROUP, LLC
Entity type:Organization
Organization Name:TEXAS SPECIALTY GROUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HARISH
Authorized Official - Middle Name:
Authorized Official - Last Name:KATHARANI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:713-660-8888
Mailing Address - Street 1:2802 GARTH ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521
Mailing Address - Country:US
Mailing Address - Phone:832-831-8031
Mailing Address - Fax:832-999-4745
Practice Address - Street 1:2802 GARTH ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521
Practice Address - Country:US
Practice Address - Phone:832-831-8031
Practice Address - Fax:832-999-4745
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEXAS SPECIALTY GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-21
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
TX286633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146599Medicaid
2135288OtherPK