Provider Demographics
NPI:1982076147
Name:SSA HOLDINGS LLC
Entity type:Organization
Organization Name:SSA HOLDINGS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER, AO
Authorized Official - Prefix:
Authorized Official - First Name:RAMAKRISHNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-676-8886
Mailing Address - Street 1:6010 S WESTERN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79110-3612
Mailing Address - Country:US
Mailing Address - Phone:806-803-9401
Mailing Address - Fax:806-803-9412
Practice Address - Street 1:6010 S WESTERN ST STE 100
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79110-3612
Practice Address - Country:US
Practice Address - Phone:806-803-9401
Practice Address - Fax:806-803-9412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-28
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336L0003X, 3336S0011X
TX302813336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148679Medicaid
2154864OtherPK