Healthcare Provider Details

I. General information

NPI: 1518960665
Provider Name (Legal Business Name): BIOSCRIP PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 12/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115A N. EUCLID AVE
ST. LOUIS MO
63108
US

IV. Provider business mailing address

14847 COLLECTION CENTER DR
CHICAGO IL
60693-0148
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-6676
  • Fax: 314-367-1881
Mailing address:
  • Phone: 800-753-5995
  • Fax: 952-352-6698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number006064
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number006064
License Number StateMO

VIII. Authorized Official

Name: JAMES MELANCON
Title or Position: VICE PRESIDENT
Credential:
Phone: 917-449-6939