Provider Demographics
NPI:1285953992
Name:INTEGRISCRIPT, INC.
Entity type:Organization
Organization Name:INTEGRISCRIPT, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:KOWAL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:413-750-7000
Mailing Address - Street 1:95 ASHLEY AVE STE B
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-1352
Mailing Address - Country:US
Mailing Address - Phone:413-750-7000
Mailing Address - Fax:413-732-0519
Practice Address - Street 1:95 ASHLEY AVE STE B
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-1352
Practice Address - Country:US
Practice Address - Phone:413-750-7000
Practice Address - Fax:413-732-0519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-19
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
MADS897263336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1028993Medicaid
2125145OtherPK
MA110085640AMedicaid