Provider Demographics
NPI:1619332053
Name:PHARMASCRIPT INC
Entity Type:Organization
Organization Name:PHARMASCRIPT INC
Other - Org Name:PHARMASCRIPT INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:773-681-0965
Mailing Address - Street 1:5437 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-1703
Mailing Address - Country:US
Mailing Address - Phone:773-681-0965
Mailing Address - Fax:773-961-8907
Practice Address - Street 1:5437 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640
Practice Address - Country:US
Practice Address - Phone:773-681-0965
Practice Address - Fax:773-961-8907
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER POINT HOME HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-30
Last Update Date:2020-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054.019406332BP3500X, 333600000X, 3336H0001X, 3336H0001X
332BP3500X, 3336S0011X
IN64002162A3336H0001X
IA46663336H0001X
KS22-1012553336H0001X
KYIL23573336H0001X
MO20160365363336H0001X
MN2651603336H0001X
GAPHNR0013453336H0001X
ID44909MS3336H0001X
HI13763336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL8109044208001Medicaid
2157251OtherPK
SC7L9406Medicaid
MN1619332053Medicaid
WI100069273Medicaid
IN300009646Medicaid
NM17624002Medicaid