Provider Demographics
NPI:1578557765
Name:PROTO SCRIPT PHARMACUETICALS CORP
Entity Type:Organization
Organization Name:PROTO SCRIPT PHARMACUETICALS CORP
Other - Org Name:PSP HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:RICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-476-7679
Mailing Address - Street 1:PO BOX 2462
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91729-2462
Mailing Address - Country:US
Mailing Address - Phone:800-507-8758
Mailing Address - Fax:888-819-9749
Practice Address - Street 1:337 N VINEYARD AVE STE 400
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-4436
Practice Address - Country:US
Practice Address - Phone:855-476-7679
Practice Address - Fax:909-542-3176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-02
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48177332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0569535OtherNCPDP
CA15788557765Medicaid
CA15788557765Medicaid