1417950544 NPI number — BIOSCRIP PHARMACY, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417950544 NPI number — BIOSCRIP PHARMACY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BIOSCRIP PHARMACY, 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:
BIOSCRIP 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:
1417950544
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10050 CROSSTOWN CIR
Provider Second Line Business Mailing Address:
STE 300
Provider Business Mailing Address City Name:
EDEN PRAIRIE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55344-3374
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-753-5995
Provider Business Mailing Address Fax Number:
952-352-6698

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
912 W BELMONT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60657-6466
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-665-8990
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MELANCON
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
917-449-6939

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 0054013257 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336H0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 200356880C , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2384147 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1463544 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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