Provider Demographics
NPI:1831303163
Name:SCOTT, JOHN C (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:SCOTT
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8012 FIELDSTONE AVE NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-8030
Mailing Address - Country:US
Mailing Address - Phone:505-839-7035
Mailing Address - Fax:
Practice Address - Street 1:4101 INDIAN SCHOOL RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-3988
Practice Address - Country:US
Practice Address - Phone:505-232-1767
Practice Address - Fax:505-262-7390
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4030183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist