Provider Demographics
NPI:1366445231
Name:BIOSCRIP PHARMACY, INC.
Entity Type:Organization
Organization Name:BIOSCRIP PHARMACY, INC.
Other - Org Name:BIOSCRIP PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MELANCON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-449-6939
Mailing Address - Street 1:10050 CROSSTOWN CIR
Mailing Address - Street 2:STE 300
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3374
Mailing Address - Country:US
Mailing Address - Phone:800-753-5995
Mailing Address - Fax:952-352-6698
Practice Address - Street 1:8490 SANTA MONICA BLVD
Practice Address - Street 2:STE 1
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-4261
Practice Address - Country:US
Practice Address - Phone:310-657-4333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
CAPHY435213336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA435210Medicaid
1131260016Medicare ID - Type Unspecified