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General NPI Number Information
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NPI Number | 1912508151
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Entity Type | Individual
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Provider Name | NICOLE SCOTT PHARMD
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Gender | Female
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Dates
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Enumeration Date | 11/04/2020
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Last Update Date | 11/04/2020
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Provider Practice Location Address
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Address Line | 808 W WALNUT ST
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City | ROGERS
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State | AR
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Zip | 72756-3538
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Country | US
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Telephone | 479-202-7197
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 PEAK ST
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City | CAVE SPRINGS
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State | AR
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Zip | 72718-7110
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Country | US
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Telephone | 479-619-5637
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Fax |
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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 | PD15002
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License Number State | AR
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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 | 2019024990
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License Number State | MO
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