1659374403 NPI number — BIOSCRIP PHARMACY, INC.

Table of content: (NPI 1659374403)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659374403 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:
1659374403
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/27/2012
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:
2100 LYNDALE AVE S
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55405-3686
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-872-7808
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/24/2005

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: 2621047 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 366237300 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0720193 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 33282100 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2383979 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 21487 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".




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