MEDICARE: PROTO SCRIPT PHARMACUETICALS CORP

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
1	332B00000X	Durable Medical Equipment & Medical Supplies		CA

General Provider Information

NPI Number	:	1255769139
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROTO SCRIPT PHARMACUETICALS CORP

Provider Business Mailing Address
First Line	:	3863 S VALLEY VIEW BLVD
Second Line	:	SUITE 11
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-2910
Country	:	US
Telephone Number	:	702-366-0728
Fax Number	:	702-723-4969

Provider Business Practice Location Address
First Line	:	3863 S VALLEY VIEW BLVD
Second Line	:	SUITE 11
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-2910
Country	:	US
Telephone Number	:	702-366-0728
Fax Number	:	702-723-4969

Authorized Official
Title or Position	:	GENERAL MANAGER
Name	:	TERRY MOFFIT
Credential	:
Telephone Number	:	855-476-7679

Provider Enumeration Date	:	10/31/2013
Last Update Date	:	10/23/2014

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