Provider Demographics
NPI:1194014407
Name:SCRIPT INFUSION PHARMACY, INC.
Entity Type:Organization
Organization Name:SCRIPT INFUSION PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DONATHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-296-2120
Mailing Address - Street 1:10571 CALLE LEE STE 163
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2572
Mailing Address - Country:US
Mailing Address - Phone:562-296-2120
Mailing Address - Fax:562-296-2130
Practice Address - Street 1:10571 CALLE LEE STE 163
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2572
Practice Address - Country:US
Practice Address - Phone:562-296-2120
Practice Address - Fax:562-296-2130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-07
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY504653336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1194014407Medicaid
CAPHY50465OtherPHARMACY LICENSE
CA1194014407Medicaid