Provider Demographics
NPI:1336139286
Name:SCOTT, MARY ELIZABETH (RPH,CGP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELIZABETH
Last Name:SCOTT
Suffix:
Gender:F
Credentials:RPH,CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 RECTOR ST NE
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:MI
Mailing Address - Zip Code:49345-8341
Mailing Address - Country:US
Mailing Address - Phone:616-887-5219
Mailing Address - Fax:
Practice Address - Street 1:1011 RECTOR ST NE
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:MI
Practice Address - Zip Code:49345-8341
Practice Address - Country:US
Practice Address - Phone:616-887-5219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302029288183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist