Healthcare Provider Details

I. General information

NPI: 1578571097
Provider Name (Legal Business Name): JESSE GAELEN SCOTT PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3804 EASTSIDE HWY
STEVENSVILLE MT
59870-2224
US

IV. Provider business mailing address

343 BRAYTON WAY
FLORENCE MT
59833-6851
US

V. Phone/Fax

Practice location:
  • Phone: 406-777-5002
  • Fax: 406-777-6924
Mailing address:
  • Phone: 406-777-4749
  • Fax: 406-777-4749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4988
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: