Provider Demographics
NPI:1023427358
Name:SCOTT, KIMBERLY LAUREN (PHARMD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LAUREN
Last Name:SCOTT
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 1:3150 KYLEMORE RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3329
Mailing Address - Country:US
Mailing Address - Phone:216-338-3283
Mailing Address - Fax:
Practice Address - Street 1:3362 NAVARRE AVE
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3314
Practice Address - Country:US
Practice Address - Phone:419-690-8269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03233929183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist