Provider Demographics
NPI:1346319498
Name:SCOTT, MICHELLE NICOLE (CPHT)
Entity Type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:NICOLE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2580 BROWDER HOLLOW RD LOT 26
Mailing Address - Street 2:
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37771-8166
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:501 ADESSA PKWY STE A150
Practice Address - Street 2:
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37771-6719
Practice Address - Country:US
Practice Address - Phone:865-986-4530
Practice Address - Fax:865-986-4909
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2001-1108-2401-772183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0000023597OtherTN. PHARMACY BOARD
TN4438568OtherNCPDP
TN4438568OtherNCPDP