Healthcare Provider Details

I. General information

NPI: 1336234293
Provider Name (Legal Business Name): J SCOTT PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 12/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 N GLENOAKS BLVD
BURBANK CA
91504-2829
US

IV. Provider business mailing address

2200 N GLENOAKS BLVD
BURBANK CA
91504-2829
US

V. Phone/Fax

Practice location:
  • Phone: 818-845-8313
  • Fax: 818-845-8975
Mailing address:
  • Phone: 818-845-8313
  • Fax: 818-845-8975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY40912
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ALBERT DAHER
Title or Position: OWNER/PHH
Credential:
Phone: 818-845-8313