Provider Demographics
NPI:1245250729
Name:DONALD E SCARCLIFF
Entity type:Organization
Organization Name:DONALD E SCARCLIFF
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER REGISTERED PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCARCLIFF
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:251-456-2273
Mailing Address - Street 1:3703 SAINT STEPHENS RD
Mailing Address - Street 2:
Mailing Address - City:WHISTLER
Mailing Address - State:AL
Mailing Address - Zip Code:36612-1225
Mailing Address - Country:US
Mailing Address - Phone:251-456-2273
Mailing Address - Fax:251-456-2221
Practice Address - Street 1:3703 SAINT STEPHENS RD
Practice Address - Street 2:
Practice Address - City:WHISTLER
Practice Address - State:AL
Practice Address - Zip Code:36612-1225
Practice Address - Country:US
Practice Address - Phone:251-456-2273
Practice Address - Fax:251-456-2221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11034183500000X
AL1112863336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100003000Medicaid
AL1256720001Medicare ID - Type UnspecifiedHCFA MEDICARE NUMBER