Provider Demographics
NPI:1093593691
Name:SCOTT, MICAHLA L (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICAHLA
Middle Name:L
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16218 JACKSON CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-7181
Mailing Address - Country:US
Mailing Address - Phone:719-484-0924
Mailing Address - Fax:
Practice Address - Street 1:16218 JACKSON CREEK PKWY
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-7181
Practice Address - Country:US
Practice Address - Phone:719-484-0924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO24579183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist