Provider Demographics
NPI:1235204934
Name:PROSCRIPT, INC
Entity Type:Organization
Organization Name:PROSCRIPT, INC
Other - Org Name:MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:BOYKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-293-1919
Mailing Address - Street 1:3600 WILMINGTON PIKE
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-4819
Mailing Address - Country:US
Mailing Address - Phone:937-293-1919
Mailing Address - Fax:937-293-0994
Practice Address - Street 1:3600 WILMINGTON PIKE
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-4819
Practice Address - Country:US
Practice Address - Phone:937-293-1919
Practice Address - Fax:937-293-0994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH332B00000X, 3336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2405016Medicaid
OH3646049OtherNCPDP #
OHBM8107472OtherDEA
OH3646049OtherNCPDP #
OHBM8107472OtherDEA