Healthcare Provider Details

I. General information

NPI: 1124638077
Provider Name (Legal Business Name): PHARMASCRIPT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2020
Last Update Date: 08/05/2020
Certification Date: 08/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 AMERICAS PKWY NE STE 121
ALBUQUERQUE NM
87110-9813
US

IV. Provider business mailing address

5437 N BROADWAY AVENUE
CHICAGO IL
60640
US

V. Phone/Fax

Practice location:
  • Phone: 505-407-2565
  • Fax: 505-859-4021
Mailing address:
  • Phone: 844-635-3221
  • Fax: 773-961-8907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LANRE A SHOMADE
Title or Position: PRESIDENT
Credential:
Phone: 773-275-8390