MEDICARE: BIOSCRIP PHARMACY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0003X	Community/Retail Pharmacy	PHY44191	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184627051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIOSCRIP PHARMACY, INC.

Provider Business Mailing Address
First Line	:	10050 CROSSTOWN CIR
Second Line	:	STE 300
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-3374
Country	:	US
Telephone Number	:	800-753-5995
Fax Number	:	952-352-6698

Provider Business Practice Location Address
First Line	:	3900 FIFTH AVE
Second Line	:	STE 110
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-3122
Country	:	US
Telephone Number	:	619-291-5474
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	JAMES MELANCON
Credential	:
Telephone Number	:	917-449-6939

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	12/03/2010

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