Provider Demographics
NPI:1245525153
Name:ROSSOW, SCOTT R (RPH)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:R
Last Name:ROSSOW
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 1:55 LAKE BLVD
Mailing Address - Street 2:SHOPKO PHARMACY 096
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-2500
Mailing Address - Country:US
Mailing Address - Phone:530-241-0713
Mailing Address - Fax:
Practice Address - Street 1:55 LAKE BLVD
Practice Address - Street 2:SHOPKO PHARMACY 096
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-2500
Practice Address - Country:US
Practice Address - Phone:530-241-0713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51234183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist