MEDICARE: ASCRIBERX AMERICA, 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	333600000X	Pharmacy

General Provider Information

NPI Number	:	1487115812
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASCRIBERX AMERICA, LLC

Provider Business Mailing Address
First Line	:	13020 FM 1641
Second Line	:
City	:	FORNEY
State	:	TX
Zip	:	75126-7607
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8826 N 23RD AVE STE C-5
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-4154
Country	:	US
Telephone Number	:	855-572-2070
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	REEF GILLUM
Credential	:
Telephone Number	:	972-742-3699

Provider Enumeration Date	:	03/28/2019
Last Update Date	:	03/28/2019

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