Provider Demographics
NPI:1588029615
Name:SCOTT, JOSHUA AARON (PHARM D)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:AARON
Last Name:SCOTT
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3622 S GLADWIN RD
Mailing Address - Street 2:
Mailing Address - City:PRUDENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48651-9234
Mailing Address - Country:US
Mailing Address - Phone:517-915-8240
Mailing Address - Fax:
Practice Address - Street 1:4562 W HOUGHTON LAKE DR
Practice Address - Street 2:
Practice Address - City:HOUGHTON LAKE
Practice Address - State:MI
Practice Address - Zip Code:48629-9005
Practice Address - Country:US
Practice Address - Phone:517-915-8240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-16
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302040596183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
5302040596OtherPHARMACIST LICENSE