Provider Demographics
NPI:1467463976
Name:SPECIALTY SCRIPTS LLC
Entity Type:Organization
Organization Name:SPECIALTY SCRIPTS LLC
Other - Org Name:SPECIALTY SCRIPTS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP SPECIALTY PHCY SVCS
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-833-5002
Mailing Address - Street 1:PO BOX 4286
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02723-0403
Mailing Address - Country:US
Mailing Address - Phone:800-218-5688
Mailing Address - Fax:800-830-5292
Practice Address - Street 1:187 PLYMOUTH AVE
Practice Address - Street 2:BLDG 8
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721-4320
Practice Address - Country:US
Practice Address - Phone:800-833-5002
Practice Address - Fax:800-833-4351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
MADS35093336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110020801AMedicaid
2240036OtherNCPDP PROVIDER IDENTIFICATION NUMBER
2240036OtherNCPDP PROVIDER IDENTIFICATION NUMBER