MEDICARE: JAMEL REYES SCOTT PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183700000X	Pharmacy Technician	IR60084065	WA
2	183500000X	Pharmacist	PH60378484	WA

General Provider Information

NPI Number	:	1174887491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMEL REYES SCOTT PHARMD

Provider Business Mailing Address
First Line	:	8915 MARKET PL
Second Line	:
City	:	LAKE STEVENS
State	:	WA
Zip	:	98258-4916
Country	:	US
Telephone Number	:	425-377-7110
Fax Number	:

Provider Business Practice Location Address
First Line	:	8915 MARKET PL
Second Line	:
City	:	LAKE STEVENS
State	:	WA
Zip	:	98258-4916
Country	:	US
Telephone Number	:	425-377-7110
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2012
Last Update Date	:	10/16/2014

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