Provider Demographics
NPI:1831529288
Name:PROSCRIPT LLC
Entity type:Organization
Organization Name:PROSCRIPT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZIAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KHADER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-658-0001
Mailing Address - Street 1:9292 N MERIDIAN ST
Mailing Address - Street 2:STE 103
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1857
Mailing Address - Country:US
Mailing Address - Phone:855-700-6001
Mailing Address - Fax:866-700-6001
Practice Address - Street 1:9292 N MERIDIAN ST STE 103
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1828
Practice Address - Country:US
Practice Address - Phone:855-700-6001
Practice Address - Fax:866-700-6001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-22
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0004X, 333600000X
IN60006360A3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2143338OtherPK