Provider Demographics
NPI:1467057117
Name:GARVIN, SCOTT J (PHARMD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:J
Last Name:GARVIN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 W SIENNA LN APT 6209
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-7869
Mailing Address - Country:US
Mailing Address - Phone:309-714-0333
Mailing Address - Fax:
Practice Address - Street 1:1008 W GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:BARTONVILLE
Practice Address - State:IL
Practice Address - Zip Code:61607-1851
Practice Address - Country:US
Practice Address - Phone:309-697-8122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051303422183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist