Provider Demographics
NPI:1922387984
Name:CERCE, SCOTT
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:
Last Name:CERCE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 BALD HILL RD
Mailing Address - Street 2:T-1188
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4233
Mailing Address - Country:US
Mailing Address - Phone:401-821-8283
Mailing Address - Fax:401-821-8283
Practice Address - Street 1:1245 BALD HILL RD
Practice Address - Street 2:T-1188
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4233
Practice Address - Country:US
Practice Address - Phone:401-821-8283
Practice Address - Fax:401-821-8283
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-09
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH03411183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist