Healthcare Provider Details

I. General information

NPI: 1457636045
Provider Name (Legal Business Name): REBECCA JOYCE SCOTT PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2011
Last Update Date: 05/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36TH MEDICAL GROUP UNIT 14010 BLDG 26001
APO AP
96543
US

IV. Provider business mailing address

36TH MEDICAL GROUP UNIT 14010 BLDG 26001
APO AP
96543
US

V. Phone/Fax

Practice location:
  • Phone: 671-366-5271
  • Fax:
Mailing address:
  • Phone: 671-366-5271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number38450
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: