Provider Demographics
NPI:1245833490
Name:SCOTT, CASSIE MARIE (CPHT)
Entity type:Individual
Prefix:MRS
First Name:CASSIE
Middle Name:MARIE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:MISS
Other - First Name:CASSIE
Other - Middle Name:MARIE
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:103 W STADIUM DR
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27288-3329
Mailing Address - Country:US
Mailing Address - Phone:336-627-4854
Mailing Address - Fax:336-627-8925
Practice Address - Street 1:103 W STADIUM DR
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-3329
Practice Address - Country:US
Practice Address - Phone:336-627-4854
Practice Address - Fax:336-627-8925
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26893183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician