Provider Demographics
NPI:1194023028
Name:SMULLEN, SCOTT (PHARMD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:SMULLEN
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 1:3707 NORTH MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-2227
Mailing Address - Country:US
Mailing Address - Phone:360-993-8604
Mailing Address - Fax:360-993-8608
Practice Address - Street 1:3707 MAIN ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-2227
Practice Address - Country:US
Practice Address - Phone:360-993-8604
Practice Address - Fax:360-993-8608
Is Sole Proprietor?:No
Enumeration Date:2011-03-01
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60203050183500000X
OR0012353183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist