Healthcare Provider Details

I. General information

NPI: 1740177385
Provider Name (Legal Business Name): KSP BIOSCRIPT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2008 W 119TH ST STE 7
CHICAGO IL
60643-4818
US

IV. Provider business mailing address

2008 W 119TH ST STE 7
CHICAGO IL
60643-4818
US

V. Phone/Fax

Practice location:
  • Phone: 866-454-7267
  • Fax: 872-762-5326
Mailing address:
  • Phone: 866-454-7267
  • Fax: 872-762-5326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: KENSHENA PIERCE
Title or Position: MANAGING MEMBER
Credential:
Phone: 708-690-8895