Provider Demographics
NPI:1699376020
Name:SCOTT, MISTELLE H
Entity Type:Individual
Prefix:
First Name:MISTELLE
Middle Name:H
Last Name:SCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 GREASY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24739-6900
Mailing Address - Country:US
Mailing Address - Phone:304-431-2105
Mailing Address - Fax:
Practice Address - Street 1:201 GREASY RIDGE RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24739-6900
Practice Address - Country:US
Practice Address - Phone:304-431-2105
Practice Address - Fax:304-431-2116
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0005822183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist