Provider Demographics
NPI:1952933152
Name:SCOTT'S QUITMAN PHARMACY, LLC
Entity Type:Organization
Organization Name:SCOTT'S QUITMAN PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TECHNICIAN/OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:EVETTE
Authorized Official - Last Name:WAKEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-763-9600
Mailing Address - Street 1:310 E GOODE ST
Mailing Address - Street 2:ADDRESS 2
Mailing Address - City:QUITMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75783
Mailing Address - Country:US
Mailing Address - Phone:903-763-9600
Mailing Address - Fax:
Practice Address - Street 1:310 E GOODE ST
Practice Address - Street 2:STE E
Practice Address - City:QUITMAN
Practice Address - State:TX
Practice Address - Zip Code:75783
Practice Address - Country:US
Practice Address - Phone:903-763-9600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-06
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy