Provider Demographics
NPI:1750526828
Name:HOME INFUSION SOLUTIONS LLC
Entity type:Organization
Organization Name:HOME INFUSION SOLUTIONS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-484-6262
Mailing Address - Street 1:1001 GRAND ST S
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-3384
Mailing Address - Country:US
Mailing Address - Phone:609-484-6262
Mailing Address - Fax:609-383-9117
Practice Address - Street 1:780 DEDHAM ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-1415
Practice Address - Country:US
Practice Address - Phone:617-989-0888
Practice Address - Fax:617-989-0188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336S0011X
MACS896393336H0001X
MADS896393336S0011X, 3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2118047OtherPK
2242597OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MA0423050Medicaid
MA0424170Medicaid