MEDICARE: MR. WESLEY ERIC SCOTT R.PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	5302030331	MI

General Provider Information

NPI Number	:	1790084986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WESLEY ERIC SCOTT R.PH.

Provider Business Mailing Address
First Line	:	507 N LAFAYETTE ST
Second Line	:
City	:	GREENVILLE
State	:	MI
Zip	:	48838-1166
Country	:	US
Telephone Number	:	616-754-3625
Fax Number	:	616-754-2726

Provider Business Practice Location Address
First Line	:	507 N LAFAYETTE ST
Second Line	:
City	:	GREENVILLE
State	:	MI
Zip	:	48838-1166
Country	:	US
Telephone Number	:	616-754-3625
Fax Number	:	616-754-2726

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2011
Last Update Date	:	03/28/2011

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