Provider Demographics
NPI:1750638177
Name:SCOTT, COREY RUSSELL (PHARMD AAHIVP APH)
Entity type:Individual
Prefix:DR
First Name:COREY
Middle Name:RUSSELL
Last Name:SCOTT
Suffix:
Gender:M
Credentials:PHARMD AAHIVP APH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 EUCLID AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-2951
Mailing Address - Country:US
Mailing Address - Phone:636-584-5078
Mailing Address - Fax:
Practice Address - Street 1:610 EUCLID AVE STE 200
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2951
Practice Address - Country:US
Practice Address - Phone:619-267-9257
Practice Address - Fax:619-267-9257
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2024-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH-728981835P2201X, 183500000X, 1835P0018X
MO2012023178183500000X
COPHA.0020220183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
No183500000XPharmacy Service ProvidersPharmacist