Provider Demographics
NPI:1518152826
Name:SCOTT, KIM L (RPH)
Entity Type:Individual
Prefix:MR
First Name:KIM
Middle Name:L
Last Name:SCOTT
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 1:6118 W BLUEMOUND RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53213-4143
Mailing Address - Country:US
Mailing Address - Phone:414-771-5606
Mailing Address - Fax:414-774-2987
Practice Address - Street 1:6118 W BLUEMOUND RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53213-4143
Practice Address - Country:US
Practice Address - Phone:414-771-5606
Practice Address - Fax:414-774-2987
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9601040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI9601040OtherSTATE LICENSE NUMBER