Provider Demographics
NPI:1720129042
Name:SCOTT, JAN G (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:G
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 HUFFER RD
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-7611
Mailing Address - Country:US
Mailing Address - Phone:912-384-6271
Mailing Address - Fax:912-384-6271
Practice Address - Street 1:1401 HUFFER RD
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-7611
Practice Address - Country:US
Practice Address - Phone:912-345-1021
Practice Address - Fax:912-345-1023
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA15739183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist