MEDICARE: PROSCRIPT PHARMACY 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	3336M0002X	Mail Order Pharmacy	026894	NY

General Provider Information

NPI Number	:	1871606152
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROSCRIPT PHARMACY LLC.

Provider Business Mailing Address
First Line	:	2556 ARTHUR KILL RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10309-1226
Country	:	US
Telephone Number	:	866-646-1780
Fax Number	:	718-966-6410

Provider Business Practice Location Address
First Line	:	2556 ARTHUR KILL RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10309-1226
Country	:	US
Telephone Number	:	866-646-1780
Fax Number	:	718-966-6410

Authorized Official
Title or Position	:	VICE PRES PHARMACY SERVICES
Name	:	MR. LOUIS MAGNOTTI
Credential	:	PHARMACIST
Telephone Number	:	718-303-7752

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	08/22/2020

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