Provider Demographics
NPI:1952682668
Name:SCARBROUGH, MARTHA (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:SCARBROUGH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 HART CIR
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:37763-7122
Mailing Address - Country:US
Mailing Address - Phone:865-463-7862
Mailing Address - Fax:
Practice Address - Street 1:245 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:TN
Practice Address - Zip Code:37716-3603
Practice Address - Country:US
Practice Address - Phone:865-463-7862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26890183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist