Provider Demographics
NPI:1942620836
Name:SCARBOROUGH, KRIS
Entity Type:Individual
Prefix:
First Name:KRIS
Middle Name:
Last Name:SCARBOROUGH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:KRIS
Other - Middle Name:N
Other - Last Name:SCARBOROUGH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:3105 CUMBIE RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:AL
Mailing Address - Zip Code:36352-8780
Mailing Address - Country:US
Mailing Address - Phone:334-818-1093
Mailing Address - Fax:
Practice Address - Street 1:3105 CUMBIE RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:AL
Practice Address - Zip Code:36352-8780
Practice Address - Country:US
Practice Address - Phone:334-818-1093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-18
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7235183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist