Provider Demographics
NPI:1710977970
Name:J L SCOTT INC
Entity Type:Organization
Organization Name:J L SCOTT INC
Other - Org Name:CIRCLE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLEOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-792-2717
Mailing Address - Street 1:PO BOX 849
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36302-0849
Mailing Address - Country:US
Mailing Address - Phone:334-792-2717
Mailing Address - Fax:334-792-9408
Practice Address - Street 1:2021 ALEXANDER DR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-3003
Practice Address - Country:US
Practice Address - Phone:334-792-2717
Practice Address - Fax:334-792-9408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AL1023753336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1988234OtherPK
AL00001243Medicaid
0102791OtherNCPDP PROVIDER IDENTIFICATION NUMBER