Healthcare Provider Details

I. General information

NPI: 1205400280
Provider Name (Legal Business Name): SCOTT MYERS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2021
Last Update Date: 05/14/2021
Certification Date: 05/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 NEWPORT AVE
PAWTUCKET RI
02861-2641
US

IV. Provider business mailing address

53 FARMERS LN
ATTLEBORO MA
02703-1100
US

V. Phone/Fax

Practice location:
  • Phone: 401-726-0724
  • Fax:
Mailing address:
  • Phone: 508-922-4917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberRPH04009
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberRPH04009
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: