Provider Demographics
NPI:1598056491
Name:BLEVINS, SCOTT W (RPH, MBA)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:W
Last Name:BLEVINS
Suffix:
Gender:M
Credentials:RPH, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4050 INNSLAKE DR
Mailing Address - Street 2:SUITE 308
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-3327
Mailing Address - Country:US
Mailing Address - Phone:804-955-4497
Mailing Address - Fax:
Practice Address - Street 1:4050 INNSLAKE DR
Practice Address - Street 2:SUITE 308
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-3327
Practice Address - Country:US
Practice Address - Phone:804-955-4497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202011010183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist