Provider Demographics
NPI:1609045137
Name:DENNIS SCARBROUGH
Entity Type:Organization
Organization Name:DENNIS SCARBROUGH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SCARBROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:904-772-8998
Mailing Address - Street 1:7900 103RD ST
Mailing Address - Street 2:SUITE 14
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-6681
Mailing Address - Country:US
Mailing Address - Phone:904-772-8998
Mailing Address - Fax:904-772-1979
Practice Address - Street 1:7900 103RD ST
Practice Address - Street 2:SUITE 14
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-6681
Practice Address - Country:US
Practice Address - Phone:904-772-8998
Practice Address - Fax:904-772-1979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH0012202332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0334940001Medicare NSC