Provider Demographics
NPI:1679081467
Name:PPG SCRIPT INC
Entity Type:Organization
Organization Name:PPG SCRIPT INC
Other - Org Name:RXXPRESS HEALTH MART PHARMACY LTC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GRISNIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-458-8420
Mailing Address - Street 1:111 MILL ST
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16127-1514
Mailing Address - Country:US
Mailing Address - Phone:724-458-8420
Mailing Address - Fax:724-458-4216
Practice Address - Street 1:111 MILL ST
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:PA
Practice Address - Zip Code:16127-1514
Practice Address - Country:US
Practice Address - Phone:724-458-8420
Practice Address - Fax:724-458-4216
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PPG SCRIPT, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-16
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP410989L3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012208220001Medicaid