Provider Demographics
NPI:1316399488
Name:JARVIS, SCOTT WRIGHT (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:WRIGHT
Last Name:JARVIS
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 OBERLIN RD APT 179
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27605-1481
Mailing Address - Country:US
Mailing Address - Phone:919-259-3093
Mailing Address - Fax:
Practice Address - Street 1:3101 NEW BERN AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1216
Practice Address - Country:US
Practice Address - Phone:919-231-5074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26147183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist