Provider Demographics
NPI:1407461593
Name:SCOTT G PETRIE MD APMC
Entity Type:Organization
Organization Name:SCOTT G PETRIE MD APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NCPDP COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MACKENZIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-590-0808
Mailing Address - Street 1:200 RITTENHOUSE CIRCLE
Mailing Address - Street 2:EAST BUILDING STE 5
Mailing Address - City:BRISTOL
Mailing Address - State:PA
Mailing Address - Zip Code:19007
Mailing Address - Country:US
Mailing Address - Phone:888-590-0808
Mailing Address - Fax:267-573-3326
Practice Address - Street 1:1014 WEST ST CLARE BOULEVARD
Practice Address - Street 2:STE 1020
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737
Practice Address - Country:US
Practice Address - Phone:225-743-2008
Practice Address - Fax:225-743-2010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site