1881697530 NPI number — BIOSCRIP PHARMACY, INC.

Table of content: (NPI 1881697530)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881697530 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:
Provider Other Organization Name Type Code:
6
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:
1881697530
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:
1669 MERIDIAN AVE
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
MIAMI BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33139-2842
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-534-1980
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/25/2005

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:  PH0015155 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PH0015155 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000246100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1080275 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0577205 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 105451100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6027148 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 105449001 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0220422 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30702615 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7F5155 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007771500012 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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