Healthcare Provider Details

I. General information

NPI: 1518989961
Provider Name (Legal Business Name): NANCY KAY SCOTT ET AL PTR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E 2ND ST
MILAN MO
63556-1331
US

IV. Provider business mailing address

111 E 2ND STREET
MILAN MO
63556
US

V. Phone/Fax

Practice location:
  • Phone: 660-265-3779
  • Fax: 660-265-3966
Mailing address:
  • Phone: 660-265-3779
  • Fax: 660-265-3966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2004008818
License Number StateMO

VIII. Authorized Official

Name: MRS. NANCY K. SCOTT
Title or Position: OWNER/OPERATOR/PHARMACY TECHNICIAN
Credential:
Phone: 660-265-3779