MEDICARE: SCRIPTSITE LTC 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
2	3336L0003X	Long Term Care Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PHY60646	OTHER	CA	BOARD OF PHARMACY

General Provider Information

NPI Number	:	1932105897
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCRIPTSITE LTC LLC

Provider Business Mailing Address
First Line	:	2173 HARBOR BAY PKWY
Second Line	:
City	:	ALAMEDA
State	:	CA
Zip	:	94502-3019
Country	:	US
Telephone Number	:	510-864-4199
Fax Number	:	510-864-4196

Provider Business Practice Location Address
First Line	:	2173 HARBOR BAY PKWY
Second Line	:
City	:	ALAMEDA
State	:	CA
Zip	:	94502-3019
Country	:	US
Telephone Number	:	510-864-4199
Fax Number	:	510-864-4196

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	VINAY KUMAR JINDAL
Credential	:
Telephone Number	:	510-864-4199

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	06/03/2025

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