1265143747 NPI number — INDY SCRIPTS INC

Table of content: (NPI 1265143747)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265143747 NPI number — INDY SCRIPTS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INDY SCRIPTS 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:
Provider Other Organization Name Type Code:
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:
1265143747
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/06/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5343 W 38TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46254-2900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-820-5454
Provider Business Mailing Address Fax Number:
317-820-5454

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5343 W 38TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46254-2900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-820-5454
Provider Business Practice Location Address Fax Number:
317-820-5454
Provider Enumeration Date:
12/06/2022

Additional Information

Authorized Official

Authorized Official Last Name:
ATEM
Authorized Official First Name:
LESLIE
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACIST/OWNER
Authorized Official Telephone Number:
317-820-5454

Provider Taxonomy Codes

  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 60006663A . This is a "PHARMACY LICENSE NUMBER" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com