Provider Demographics
NPI:1760082218
Name:MUNGER, SCOTT BOSWELL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:BOSWELL
Last Name:MUNGER
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 1:12740 FRANK DR S
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33776-1726
Mailing Address - Country:US
Mailing Address - Phone:352-262-2428
Mailing Address - Fax:
Practice Address - Street 1:41232 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-5106
Practice Address - Country:US
Practice Address - Phone:727-940-9295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS43610183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist