Provider Demographics
NPI:1740261148
Name:SCOTTS FAMILY PHARMACY INC
Entity type:Organization
Organization Name:SCOTTS FAMILY PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:D
Authorized Official - Last Name:EDGAR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:217-784-8242
Mailing Address - Street 1:220 N SANGAMON AVE
Mailing Address - Street 2:
Mailing Address - City:GIBSON CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60936-1345
Mailing Address - Country:US
Mailing Address - Phone:217-784-8242
Mailing Address - Fax:217-784-5506
Practice Address - Street 1:220 N SANGAMON AVE
Practice Address - Street 2:
Practice Address - City:GIBSON CITY
Practice Address - State:IL
Practice Address - Zip Code:60936-1345
Practice Address - Country:US
Practice Address - Phone:217-784-8242
Practice Address - Fax:217-784-5506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========002Medicaid
IL=========002Medicaid