=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609867167
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | J L SCOTT INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/03/2005
-----------------------------------------------------
Last Update Date | 01/02/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2021 ALEXANDER DR STE B
-----------------------------------------------------
City | DOTHAN
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36301-3003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-792-2717
-----------------------------------------------------
Fax | 334-792-7917
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2021 ALEXANDER DR STE B
-----------------------------------------------------
City | DOTHAN
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36301-3003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-792-2717
-----------------------------------------------------
Fax | 334-792-7917
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | MR. ZACHARY C MCLEOD
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 334-792-2717
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number | 108711
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------