MEDICARE: SCOTT E. CORCORAN

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	183500000X	Pharmacist	4321	SD

General Provider Information

NPI Number	:	1437286200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT E. CORCORAN

Provider Business Mailing Address
First Line	:	8406 CHERRY VALLEY LN
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22309-2120
Country	:	US
Telephone Number	:	703-373-3097
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 LUKE AVE
Second Line	:	ROOM 400, HQ USAF SG8X
City	:	BOLLING AIR FORCE BASE
State	:	DC
Zip	:	20032-7050
Country	:	US
Telephone Number	:	202-767-0297
Fax Number	:	202-767-5053

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

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	07/08/2007

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Directions to “ SCOTT E. CORCORAN ” Practice Location

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