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General NPI Number Information
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NPI Number | 1619197274
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Entity Type | Individual
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Provider Name | SCOTT S COURSEN RPH
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Gender | Male
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3315 N RIDGE RD E STE 100
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City | ASHTABULA
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State | OH
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Zip | 44004-4347
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Country | US
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Telephone | 440-992-7477
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Fax | 440-992-1513
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Provider Business Mailing Address
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Address Line | 5511 DIBBLE RD
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City | KINGSVILLE
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State | OH
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Zip | 44048-9807
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Country | US
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Telephone | 440-224-3393
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Fax | 440-992-1513
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 03-3-16988
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PR4399
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License Number State | ME
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