Provider Demographics
NPI:1457643041
Name:SCARBOROUGH, JON TAYLOR (RPH)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:TAYLOR
Last Name:SCARBOROUGH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:557 GARDEN TERRACE DR
Mailing Address - Street 2:UNIT 304
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-4083
Mailing Address - Country:US
Mailing Address - Phone:910-795-5363
Mailing Address - Fax:
Practice Address - Street 1:6805 PARKER FARM DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3168
Practice Address - Country:US
Practice Address - Phone:910-256-4159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-14
Last Update Date:2011-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16272183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist