Provider Demographics
NPI:1275613994
Name:SOMERFIELD, SCOTT W (RPH)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:W
Last Name:SOMERFIELD
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 1:686 W M 55
Mailing Address - Street 2:
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661-9084
Mailing Address - Country:US
Mailing Address - Phone:989-345-3256
Mailing Address - Fax:
Practice Address - Street 1:306 W LAKE ST
Practice Address - Street 2:
Practice Address - City:TAWAS CITY
Practice Address - State:MI
Practice Address - Zip Code:48763-8308
Practice Address - Country:US
Practice Address - Phone:989-362-3311
Practice Address - Fax:989-362-5733
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302030659183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist