Healthcare Provider Details

I. General information

NPI: 1184547234
Provider Name (Legal Business Name): MARY J SCROGGS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4098 LIBRA DR
ORLANDO FL
32816-3333
US

IV. Provider business mailing address

4098 LIBRA DR
ORLANDO FL
32816-3333
US

V. Phone/Fax

Practice location:
  • Phone: 407-823-6337
  • Fax: 407-823-6756
Mailing address:
  • Phone: 407-823-6337
  • Fax: 407-823-6756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS27784
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: