Healthcare Provider Details

I. General information

NPI: 1528173929
Provider Name (Legal Business Name): DEAN CARROLL SCARBROUGH RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 W MAIN ST
DESHLER OH
43516-1159
US

IV. Provider business mailing address

505 S BUTTERNUT ST
DESHLER OH
43516-1339
US

V. Phone/Fax

Practice location:
  • Phone: 419-278-1851
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number03-3-10444
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: