Provider Demographics
NPI:1629430301
Name:SCOTT, JAKE (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:JAKE
Middle Name:
Last Name:SCOTT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9101 MENDENHALL MALL RD
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-7113
Mailing Address - Country:US
Mailing Address - Phone:907-789-0458
Mailing Address - Fax:
Practice Address - Street 1:9101 MENDENHALL MALL RD
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-7113
Practice Address - Country:US
Practice Address - Phone:907-789-0458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2181183500000X
OK15593183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist