Provider Demographics
NPI:1932690286
Name:SCOTT, IRENE G (PHARM D)
Entity Type:Individual
Prefix:MS
First Name:IRENE
Middle Name:G
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10355 TRINITY PKWY
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-7243
Mailing Address - Country:US
Mailing Address - Phone:109-235-1505
Mailing Address - Fax:209-235-1498
Practice Address - Street 1:10355 TRINITY PKWY
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-7243
Practice Address - Country:US
Practice Address - Phone:109-235-1505
Practice Address - Fax:209-235-1498
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33140183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist