Provider Demographics
NPI:1700268901
Name:ALTCARE HEALTH SERVICES INC
Entity Type:Organization
Organization Name:ALTCARE HEALTH SERVICES INC
Other - Org Name:ALTSCRIPTS SPECIALTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MAGED
Authorized Official - Middle Name:
Authorized Official - Last Name:GINDI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:626-962-1061
Mailing Address - Street 1:837 W ARROW HWY
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-5413
Mailing Address - Country:US
Mailing Address - Phone:626-962-1061
Mailing Address - Fax:626-962-1157
Practice Address - Street 1:1636 MILLER PARK WAY
Practice Address - Street 2:
Practice Address - City:WEST MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53214-3604
Practice Address - Country:US
Practice Address - Phone:414-385-9500
Practice Address - Fax:414-385-7200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-24
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251F00000X, 333600000X, 3336H0001X
WI9330-423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100046600Medicaid
2152725OtherPK