Provider Demographics
NPI:1013227396
Name:SCRIPTWAY PHARMACY LLC
Entity Type:Organization
Organization Name:SCRIPTWAY PHARMACY LLC
Other - Org Name:SCRIPTWAY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:SALEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-729-7979
Mailing Address - Street 1:1911 BEAVER ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128-1404
Mailing Address - Country:US
Mailing Address - Phone:734-729-7979
Mailing Address - Fax:734-729-7323
Practice Address - Street 1:1207 S WAYNE RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-4362
Practice Address - Country:US
Practice Address - Phone:734-729-7979
Practice Address - Fax:734-729-7323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010094343336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2127295OtherPK