MEDICARE: SIMPLE SCRIPT, LLC

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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1396364501
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIMPLE SCRIPT, LLC

Provider Business Mailing Address
First Line	:	14234 W WARREN AVE
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48126-1457
Country	:	US
Telephone Number	:	313-461-2772
Fax Number	:

Provider Business Practice Location Address
First Line	:	14234 W WARREN AVE
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48126-1457
Country	:	US
Telephone Number	:	313-461-2772
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	HUSSEIN G CHEAITO
Credential	:
Telephone Number	:	313-461-2772

Provider Enumeration Date	:	04/09/2020
Last Update Date	:	04/09/2020

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Directions to “SIMPLE SCRIPT, LLC ” Practice Location

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