Provider Demographics
NPI:1619197274
Name:COURSEN, SCOTT S (RPH)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:S
Last Name:COURSEN
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 1:5511 DIBBLE RD
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44048-9807
Mailing Address - Country:US
Mailing Address - Phone:440-224-3393
Mailing Address - Fax:440-992-1513
Practice Address - Street 1:3315 N RIDGE RD E STE 100
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-4347
Practice Address - Country:US
Practice Address - Phone:440-992-7477
Practice Address - Fax:440-992-1513
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-16988183500000X
MEPR4399183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist