Basic Information
Provider Information | |||||||||
NPI: | 1124399670 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | BIO SCRIPT PHARMACY LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | BIO SCRIPT PHARMACY | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 15348 FORT STREET | ||||||||
Address2: |   | ||||||||
City: | SOUTHGATE | ||||||||
State: | MI | ||||||||
PostalCode: | 48195 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8133042221 | ||||||||
FaxNumber: | 8882398423 | ||||||||
Practice Location | |||||||||
Address1: | 15348 FORT ST | ||||||||
Address2: |   | ||||||||
City: | SOUTHGATE | ||||||||
State: | MI | ||||||||
PostalCode: | 481951304 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7343244000 | ||||||||
FaxNumber: | 7343244055 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/14/2012 | ||||||||
LastUpdateDate: | 08/25/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | PATEL | ||||||||
AuthorizedOfficialFirstName: | ALPESH | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
AuthorizedOfficialTelephone: | 8133042221 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 08/25/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336S0011X |   |   | N |   | Suppliers | Pharmacy | Specialty Pharmacy | 3336C0004X |   |   | N |   | Suppliers | Pharmacy | Compounding Pharmacy | 3336C0003X | 5301009737 | MI | Y |   | Suppliers | Pharmacy | Community/Retail Pharmacy |
ID Information
ID | Type | State | Issuer | Description | 2376297 | 01 |   | NCPDP PROVIDER IDENTIFICATION NUMBER | OTHER |