Provider Demographics
NPI:1407057128
Name:SCOGGIN, CARLY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CARLY
Middle Name:
Last Name:SCOGGIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:CARLY
Other - Last Name:SCOGGIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3772 ROSEDALE DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-6919
Mailing Address - Country:US
Mailing Address - Phone:901-458-0634
Mailing Address - Fax:
Practice Address - Street 1:2525 HORIZON LAKE DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111
Practice Address - Country:US
Practice Address - Phone:901-248-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26478183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist