Provider Demographics
NPI:1922290097
Name:SCRIPT DEPOT LP
Entity Type:Organization
Organization Name:SCRIPT DEPOT LP
Other - Org Name:RIVERSIDE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:KHALED
Authorized Official - Middle Name:
Authorized Official - Last Name:SEDKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-790-2786
Mailing Address - Street 1:866 PLUMAS ST
Mailing Address - Street 2:STE C
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-4022
Mailing Address - Country:US
Mailing Address - Phone:530-751-1889
Mailing Address - Fax:530-674-3698
Practice Address - Street 1:866 PLUMAS ST
Practice Address - Street 2:STE C
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-4022
Practice Address - Country:US
Practice Address - Phone:530-751-1889
Practice Address - Fax:530-674-3698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54491333600000X
3336C0003X, 3336C0004X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2164032OtherPK
2164032OtherPK
CA6066830001Medicare NSC