Healthcare Provider Details

I. General information

NPI: 1831529288
Provider Name (Legal Business Name): PROSCRIPT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2013
Last Update Date: 03/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9292 N MERIDIAN ST STE 103
INDIANAPOLIS IN
46260-1828
US

IV. Provider business mailing address

9292 N MERIDIAN ST STE 103
INDIANAPOLIS IN
46260-1857
US

V. Phone/Fax

Practice location:
  • Phone: 855-700-6001
  • Fax: 866-700-6001
Mailing address:
  • Phone: 855-700-6001
  • Fax: 866-700-6001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number60006360A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ZIAD KHADER
Title or Position: OWNER
Credential:
Phone: 317-658-0001