Provider Demographics
NPI:1881870020
Name:BORSENIK, SCOTT ALAN (RPH)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:ALAN
Last Name:BORSENIK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29955 S GIBRALTAR RD
Mailing Address - Street 2:
Mailing Address - City:GIBRALTAR
Mailing Address - State:MI
Mailing Address - Zip Code:48173-9428
Mailing Address - Country:US
Mailing Address - Phone:734-692-0545
Mailing Address - Fax:
Practice Address - Street 1:444 MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48111-2648
Practice Address - Country:US
Practice Address - Phone:734-692-0545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-17
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302028612183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist