Provider Demographics
NPI:1083216311
Name:SCOVILLE, JOSHUA J (PHARMD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:J
Last Name:SCOVILLE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 FRED MOON RD
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12138-4800
Mailing Address - Country:US
Mailing Address - Phone:518-925-4512
Mailing Address - Fax:
Practice Address - Street 1:1415 CURRAN MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:NORTH ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01247-3964
Practice Address - Country:US
Practice Address - Phone:413-664-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH233911183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist