Healthcare Provider Details

I. General information

NPI: 1255769139
Provider Name (Legal Business Name): PROTO SCRIPT PHARMACUETICALS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2013
Last Update Date: 10/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3863 S VALLEY VIEW BLVD SUITE 11
LAS VEGAS NV
89103-2910
US

IV. Provider business mailing address

3863 S VALLEY VIEW BLVD SUITE 11
LAS VEGAS NV
89103-2910
US

V. Phone/Fax

Practice location:
  • Phone: 702-366-0728
  • Fax: 702-723-4969
Mailing address:
  • Phone: 702-366-0728
  • Fax: 702-723-4969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateCA

VIII. Authorized Official

Name: TERRY MOFFIT
Title or Position: GENERAL MANAGER
Credential:
Phone: 855-476-7679