Healthcare Provider Details

I. General information

NPI: 1730366741
Provider Name (Legal Business Name): RONALD W SCOTT R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2008
Last Update Date: 12/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4005 HIGH RESORT BLVD SE
RIO RANCHO NM
87124-5906
US

IV. Provider business mailing address

4320 HODGIN LN NW
ALBUQUERQUE NM
87120-4461
US

V. Phone/Fax

Practice location:
  • Phone: 505-462-6000
  • Fax:
Mailing address:
  • Phone: 505-933-5958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5294
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPC00000159
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: