Healthcare Provider Details

I. General information

NPI: 1285953992
Provider Name (Legal Business Name): INTEGRISCRIPT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2010
Last Update Date: 04/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 ASHLEY AVE STE B
WEST SPRINGFIELD MA
01089-1352
US

IV. Provider business mailing address

95 ASHLEY AVE STE B
WEST SPRINGFIELD MA
01089-1352
US

V. Phone/Fax

Practice location:
  • Phone: 413-750-7000
  • Fax: 413-732-0519
Mailing address:
  • Phone: 413-750-7000
  • Fax: 413-732-0519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberDS89726
License Number StateMA

VIII. Authorized Official

Name: ANDREW KOWAL
Title or Position: DIRECTOR OF PHARMACY
Credential: RPH
Phone: 413-750-7000