Provider Demographics
NPI:1679179220
Name:SCOTT, SUSAN KAY (DPH)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:KAY
Last Name:SCOTT
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 BARNES AVE
Mailing Address - Street 2:
Mailing Address - City:ALVA
Mailing Address - State:OK
Mailing Address - Zip Code:73717-2288
Mailing Address - Country:US
Mailing Address - Phone:580-327-3332
Mailing Address - Fax:580-327-1848
Practice Address - Street 1:513 BARNES AVE
Practice Address - Street 2:
Practice Address - City:ALVA
Practice Address - State:OK
Practice Address - Zip Code:73717-2288
Practice Address - Country:US
Practice Address - Phone:580-327-3332
Practice Address - Fax:580-327-1848
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10321183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist