Provider Demographics
NPI:1053642041
Name:CUSTOM SCRIPT LLC
Entity Type:Organization
Organization Name:CUSTOM SCRIPT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EYAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KHADR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-588-0000
Mailing Address - Street 1:25302 W WARREN ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-2102
Mailing Address - Country:US
Mailing Address - Phone:810-588-0000
Mailing Address - Fax:888-647-8587
Practice Address - Street 1:25302 W WARREN ST
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-2102
Practice Address - Country:US
Practice Address - Phone:810-588-0000
Practice Address - Fax:888-647-8587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-15
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301009280332BC3200X, 3336C0003X
332BD1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies