=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669245809
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TREY SCARBOROUGH RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2023
-----------------------------------------------------
Last Update Date | 10/31/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1240 JESSE JEWELL PKWY SE STE 550
-----------------------------------------------------
City | GAINESVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30501-3863
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-450-7855
-----------------------------------------------------
Fax | 678-450-7857
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1240 JESSE JEWELL PKWY SE STE 550
-----------------------------------------------------
City | GAINESVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30501-3863
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-450-7855
-----------------------------------------------------
Fax | 678-450-7857
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RPH029208
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------