Provider Demographics
NPI:1366102246
Name:EQUISCRIPTRX, LLC
Entity type:Organization
Organization Name:EQUISCRIPTRX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SNOW
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:855-266-1443
Mailing Address - Street 1:307 CRANES ROOST BLVD STE 1048
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-3441
Mailing Address - Country:US
Mailing Address - Phone:855-266-1443
Mailing Address - Fax:843-823-3549
Practice Address - Street 1:307 CRANES ROOST BLVD STE 1048
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-3441
Practice Address - Country:US
Practice Address - Phone:855-266-1443
Practice Address - Fax:843-823-3549
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EQUISCRIPTRX, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy