Provider Demographics
NPI:1558638452
Name:STATSCRIPT
Entity Type:Organization
Organization Name:STATSCRIPT
Other - Org Name:STATSCRIPT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BONURA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-234-0045
Mailing Address - Street 1:PO BOX 34565
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77234-4565
Mailing Address - Country:US
Mailing Address - Phone:713-234-0045
Mailing Address - Fax:855-822-7838
Practice Address - Street 1:12817 GULF FWY STE A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77034-4804
Practice Address - Country:US
Practice Address - Phone:713-234-0045
Practice Address - Fax:855-822-7838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-19
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX277623336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2133194OtherPK
TX146508Medicaid
PH0920Medicare Oscar/Certification