Healthcare Provider Details

I. General information

NPI: 1922290097
Provider Name (Legal Business Name): SCRIPT DEPOT LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 02/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

866 PLUMAS ST STE C
YUBA CITY CA
95991-4022
US

IV. Provider business mailing address

866 PLUMAS ST STE C
YUBA CITY CA
95991-4022
US

V. Phone/Fax

Practice location:
  • Phone: 530-751-1889
  • Fax: 530-674-3698
Mailing address:
  • Phone: 530-751-1889
  • Fax: 530-674-3698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number54491
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KHALED SEDKI
Title or Position: PRESIDENT & CEO
Credential:
Phone: 248-790-2786