Provider Demographics
NPI:1770936163
Name:PROTO SCRIPT PHARMACUETICALS CORP
Entity type:Organization
Organization Name:PROTO SCRIPT PHARMACUETICALS CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NATIONAL GM/CIO/COMPLAINCE
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MOFFIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-476-7679
Mailing Address - Street 1:9830 6TH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-7968
Mailing Address - Country:US
Mailing Address - Phone:855-476-7679
Mailing Address - Fax:888-819-8749
Practice Address - Street 1:9830 6TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-7968
Practice Address - Country:US
Practice Address - Phone:855-476-7679
Practice Address - Fax:888-819-8749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies