Provider Demographics
NPI:1184762544
Name:SCOTA, PAUL CARMEN (RPH)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:CARMEN
Last Name:SCOTA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 W LEHIGH AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19133-1640
Mailing Address - Country:US
Mailing Address - Phone:215-225-7522
Mailing Address - Fax:215-225-7525
Practice Address - Street 1:1006 W LEHIGH AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19133-1640
Practice Address - Country:US
Practice Address - Phone:215-225-7522
Practice Address - Fax:215-225-7525
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP481048183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPP481048OtherSTATE LISCENSE
PA23-2957348OtherFEIN #
PA3979640OtherNCPDP #
PA1007398660003Medicaid
PABL75022342OtherDEA #