MEDICARE: MR. KIM L SCOTT RPH

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	9601040	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9601040	OTHER	WI	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1518152826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KIM L SCOTT RPH

Provider Business Mailing Address
First Line	:	6118 W BLUEMOUND RD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53213-4143
Country	:	US
Telephone Number	:	414-771-5606
Fax Number	:	414-774-2987

Provider Business Practice Location Address
First Line	:	6118 W BLUEMOUND RD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53213-4143
Country	:	US
Telephone Number	:	414-771-5606
Fax Number	:	414-774-2987

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

Provider Enumeration Date	:	09/10/2007
Last Update Date	:	09/10/2007

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Directions to “ MR. KIM L SCOTT RPH” Practice Location

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