Healthcare Provider Details

I. General information

NPI: 1235986522
Provider Name (Legal Business Name): DESTINY SCOTT PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2024
Last Update Date: 05/03/2024
Certification Date: 05/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 HIGHWAY 80 E
CLINTON MS
39056-5252
US

IV. Provider business mailing address

801 HIGHWAY 80 E
CLINTON MS
39056-5252
US

V. Phone/Fax

Practice location:
  • Phone: 601-924-2111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE-101044
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: