Provider Demographics
NPI:1518989961
Name:NANCY KAY SCOTT ET AL PTR
Entity Type:Organization
Organization Name:NANCY KAY SCOTT ET AL PTR
Other - Org Name:OWLS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR/PHARMACY TECHNICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:K
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-265-3779
Mailing Address - Street 1:111 E 2ND STREET
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:MO
Mailing Address - Zip Code:63556
Mailing Address - Country:US
Mailing Address - Phone:660-265-3779
Mailing Address - Fax:660-265-3966
Practice Address - Street 1:111 E 2ND ST
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:MO
Practice Address - Zip Code:63556-1331
Practice Address - Country:US
Practice Address - Phone:660-265-3779
Practice Address - Fax:660-265-3966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040088183336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO602151003Medicaid
MO2627593OtherNCPDP