Healthcare Provider Details

I. General information

NPI: 1932474624
Provider Name (Legal Business Name): SCRIPT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2012
Last Update Date: 06/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38300 VAN DYKE AVE SUITE 102
STERLING HEIGHTS MI
48312-1123
US

IV. Provider business mailing address

38300 VAN DYKE AVE SUITE 102
STERLING HEIGHTS MI
48312-1123
US

V. Phone/Fax

Practice location:
  • Phone: 888-510-8002
  • Fax: 888-510-8003
Mailing address:
  • Phone: 586-690-4222
  • Fax: 888-510-8003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301010430
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ZIAD KHADER
Title or Position: OWNER
Credential:
Phone: 810-588-0000