1518960665 NPI number — BIOSCRIP PHARMACY, INC.

Table of content: (NPI 1518960665)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518960665 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:
1518960665
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:
14847 COLLECTION CENTER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60693-0148
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:
115A N. EUCLID AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST. LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-454-6676
Provider Business Practice Location Address Fax Number:
314-367-1881
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 , with the licence number:  006064 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 006064 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 54013115 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 628567802 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2378716 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 608567806 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100850770F , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".