MEDICARE: DR. JESSE GAELEN 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	183500000X	Pharmacist	4988	MT

General Provider Information

NPI Number	:	1578571097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSE GAELEN SCOTT PHARMD

Provider Business Mailing Address
First Line	:	343 BRAYTON WAY
Second Line	:
City	:	FLORENCE
State	:	MT
Zip	:	59833-6851
Country	:	US
Telephone Number	:	406-777-4749
Fax Number	:	406-777-4749

Provider Business Practice Location Address
First Line	:	3804 EASTSIDE HWY
Second Line	:
City	:	STEVENSVILLE
State	:	MT
Zip	:	59870-2224
Country	:	US
Telephone Number	:	406-777-5002
Fax Number	:	406-777-6924

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

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	07/08/2007

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