Provider Demographics
NPI:1518960665
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 1:14847 COLLECTION CENTER DR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60693-0148
Mailing Address - Country:US
Mailing Address - Phone:800-753-5995
Mailing Address - Fax:952-352-6698
Practice Address - Street 1:115A N. EUCLID AVE
Practice Address - Street 2:
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108
Practice Address - Country:US
Practice Address - Phone:314-454-6676
Practice Address - Fax:314-367-1881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006064332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO628567802Medicaid
OH2378716Medicaid
OK100850770FMedicaid
MO608567806Medicaid
KY54013115Medicaid
OH2378716Medicaid
MO608567806Medicaid