Provider Demographics
NPI:1194001230
Name:EUSTIS, SCOTT MASON (RPH)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:MASON
Last Name:EUSTIS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 OLD WEBSTER RD
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-1513
Mailing Address - Country:US
Mailing Address - Phone:207-783-9321
Mailing Address - Fax:
Practice Address - Street 1:166 OLD WEBSTER RD
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-1513
Practice Address - Country:US
Practice Address - Phone:207-783-9321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME04333183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist