Provider Demographics
NPI:1932713567
Name:SCOTT, COLE WAINE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:COLE
Middle Name:WAINE
Last Name:SCOTT
Suffix:
Gender:M
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 1:905 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ARMA
Mailing Address - State:KS
Mailing Address - Zip Code:66712-4003
Mailing Address - Country:US
Mailing Address - Phone:620-404-9316
Mailing Address - Fax:
Practice Address - Street 1:2001 S RANGE LINE RD
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3240
Practice Address - Country:US
Practice Address - Phone:417-626-8553
Practice Address - Fax:417-626-8776
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-106191183500000X
MO2019014193183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2019014193OtherMISSOURI STATE BOARD OF PHARMACY
KS1-106191OtherKANSAS STATE BOARD OF PHARMACY