Provider Demographics
NPI:1295327526
Name:WORKMAN, SCOTT KEITH (PHARMACIST)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:KEITH
Last Name:WORKMAN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:
Mailing Address - City:CARUTHERS
Mailing Address - State:CA
Mailing Address - Zip Code:93609-0457
Mailing Address - Country:US
Mailing Address - Phone:559-864-3177
Mailing Address - Fax:559-864-3497
Practice Address - Street 1:2436 W TAHOE AVE
Practice Address - Street 2:
Practice Address - City:CARUTHERS
Practice Address - State:CA
Practice Address - Zip Code:93609-9476
Practice Address - Country:US
Practice Address - Phone:559-864-3177
Practice Address - Fax:559-864-3497
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37004183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA205960Medicaid