Provider Demographics
NPI:1952887101
Name:POWERS, SCOTT BRADLEY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:BRADLEY
Last Name:POWERS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5434 SOUTHFIELD CTR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-5907
Mailing Address - Country:US
Mailing Address - Phone:314-849-2363
Mailing Address - Fax:
Practice Address - Street 1:5434 SOUTHFIELD CTR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-5907
Practice Address - Country:US
Practice Address - Phone:314-849-2363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.299322183500000X
MO2014027820183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist