1154312254 NPI number — CLEAR SCRIPT COMPANY INC

Table of content: (NPI 1154312254)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154312254 NPI number — CLEAR SCRIPT COMPANY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLEAR SCRIPT COMPANY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MORANS PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154312254
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7070
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEARLAKE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95422-7070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-994-6440
Provider Business Mailing Address Fax Number:
707-944-8425

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15175 LAKESHORE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEARLAKE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95422-8106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-994-6440
Provider Business Practice Location Address Fax Number:
707-994-8425
Provider Enumeration Date:
10/30/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GREWAL
Authorized Official First Name:
GURINDER
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
707-994-6440

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PHY46732 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2035733 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: PHA467320 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".