Provider Demographics
NPI:1407162688
Name:SCOTT, JAN MYERS
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:MYERS
Last Name:SCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42345-2902
Mailing Address - Country:US
Mailing Address - Phone:270-338-3800
Mailing Address - Fax:270-338-3807
Practice Address - Street 1:117 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:KY
Practice Address - Zip Code:42345-2902
Practice Address - Country:US
Practice Address - Phone:270-338-3800
Practice Address - Fax:270-338-3807
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY08205183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY08205OtherPHARMACIST LICENSE NUMBER