MEDICARE: SCOTTPHARM ENTERPRISES LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336L0003X	Long Term Care Pharmacy
3	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790438166
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCOTTPHARM ENTERPRISES LLC

Provider Business Mailing Address
First Line	:	2720 US 1 S STE A
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32086-6371
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2720 US 1 S STE A
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32086-6371
Country	:	US
Telephone Number	:	904-484-7775
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. MARK SCOTT
Credential	:	PHARMD
Telephone Number	:	904-484-7775

Provider Enumeration Date	:	01/26/2022
Last Update Date	:	10/12/2024

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Directions to “SCOTTPHARM ENTERPRISES LLC ” Practice Location

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