Provider Demographics
NPI:1710155007
Name:LI SCRIPT LLC
Entity Type:Organization
Organization Name:LI SCRIPT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAMALOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-321-3850
Mailing Address - Street 1:333 CROSSWAYS PARK DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-2066
Mailing Address - Country:US
Mailing Address - Phone:631-321-3850
Mailing Address - Fax:631-410-0229
Practice Address - Street 1:333 CROSSWAYS PARK DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2066
Practice Address - Country:US
Practice Address - Phone:631-321-3850
Practice Address - Fax:631-410-0229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6214210001Medicare NSC