Provider Demographics
NPI:1699012310
Name:WILLIAMS, SCOTT C (RPH)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:C
Last Name:WILLIAMS
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 1:22855 N.E. PARKLANE
Mailing Address - Street 2:
Mailing Address - City:WOOD VILLAGE
Mailing Address - State:OR
Mailing Address - Zip Code:97060
Mailing Address - Country:US
Mailing Address - Phone:503-492-5033
Mailing Address - Fax:503-492-5027
Practice Address - Street 1:22855 N.E. PARKLANE
Practice Address - Street 2:
Practice Address - City:WOOD VILLAGE
Practice Address - State:OR
Practice Address - Zip Code:97060
Practice Address - Country:US
Practice Address - Phone:503-492-5033
Practice Address - Fax:503-492-5027
Is Sole Proprietor?:No
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8412183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist