Provider Demographics
NPI:1659500312
Name:VOURI, SCOTT MARTIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:MARTIN
Last Name:VOURI
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 1:4588 PARKVIEW PL
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1029
Mailing Address - Country:US
Mailing Address - Phone:314-880-8534
Mailing Address - Fax:
Practice Address - Street 1:3900 S GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-3414
Practice Address - Country:US
Practice Address - Phone:314-880-8535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26023219A183500000X
MO2011012782183500000X
TX49036183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist