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NPI Code Detail

MEDICARE: CUSTOM SCRIPT LLC

MEDICARE: CUSTOM SCRIPT LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332BC3200XCustomized Equipment (DME)5301009280MI
2332BD1200XDialysis Equipment & Supplies (DME)
33336C0003XCommunity/Retail Pharmacy5301009280MI

General Provider Information

NPI Number : 1053642041
Entity Type Code : Organization
Provider Name (Legal Business Name) : CUSTOM SCRIPT LLC
Provider Business Mailing Address
First Line : 25302 W WARREN ST
Second Line :
City : DEARBORN HEIGHTS
State : MI
Zip : 48127-2102
Country : US
Telephone Number : 810-588-0000
Fax Number : 888-647-8587
Provider Business Practice Location Address
First Line : 25302 W WARREN ST
Second Line :
City : DEARBORN HEIGHTS
State : MI
Zip : 48127-2102
Country : US
Telephone Number : 810-588-0000
Fax Number : 888-647-8587
Authorized Official
Title or Position : OWNER
Name : MR. EYAD KHADR
Credential :
Telephone Number : 810-588-0000
Provider Enumeration Date : 01/15/2010
Last Update Date : 03/23/2015

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Directions to “CUSTOM SCRIPT LLC ” Practice Location

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