=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629497904
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTHSCRIPTS OF AMERICA-NORTH SHORE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2014
-----------------------------------------------------
Last Update Date | 04/15/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 PRODUCTION DR SUITE D
-----------------------------------------------------
City | SLIDELL
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70460-4674
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 855-214-5235
-----------------------------------------------------
Fax | 855-214-5250
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6565 WEST LOOP S SUITE 110
-----------------------------------------------------
City | BELLAIRE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77401-3500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-494-3210
-----------------------------------------------------
Fax | 832-494-3218
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | KAMRAN NEZAMI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 832-494-3210
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PHY.006874
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------