=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316940380
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BIOSCRIP PHARMACY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/24/2005
-----------------------------------------------------
Last Update Date | 12/03/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 342 MASSACHUSETTS AVE STE 103
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46204-2192
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-631-6000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10050 CROSSTOWN CIR STE 300
-----------------------------------------------------
City | EDEN PRAIRIE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55344-3374
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-753-5995
-----------------------------------------------------
Fax | 952-352-6698
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | JAMES MELANCON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 917-449-6939
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 60005193
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------