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General NPI Number Information
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NPI Number | 1104026343
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Entity Type | Organization
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Legal Business Name | SMARTSCRIPT PHARMACY LLC
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Dates
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Enumeration Date | 07/24/2007
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Last Update Date | 02/27/2017
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Provider Practice Location Address
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Address Line | 4041 STATE ROAD 91 STE B
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City | OSHKOSH
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State | WI
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Zip | 54904-9218
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Country | US
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Telephone | 844-476-2781
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Fax | 844-245-7075
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Provider Business Mailing Address
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Address Line | 4041 STATE ROAD 91 STE B
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City | OSHKOSH
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State | WI
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Zip | 54904-9218
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Country | US
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Telephone | 844-476-2781
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Fax | 844-245-7075
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Authorized Official
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Title or Position | OWNER
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Name | DAN LEBEN
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Credential | BUSINESS
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Telephone | 844-476-2781
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | 9267-42
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License Number State | WI
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