MEDICARE: SCOTT'S PHARMACY AND COMPOUNDING LAB

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	3336C0003X	Community/Retail Pharmacy	PHRE010170	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2153689	OTHER		PK

General Provider Information

NPI Number	:	1891162954
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCOTT'S PHARMACY AND COMPOUNDING LAB

Provider Business Mailing Address
First Line	:	2205 E OGLETHORPE BLVD
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31705-2939
Country	:	US
Telephone Number	:	229-483-7908
Fax Number	:

Provider Business Practice Location Address
First Line	:	2205 E OGLETHORPE BLVD
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31705-2939
Country	:	US
Telephone Number	:	229-483-7908
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	PAUL SCOTT
Credential	:
Telephone Number	:	706-224-2047

Provider Enumeration Date	:	08/25/2015
Last Update Date	:	08/25/2015

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Directions to “SCOTT'S PHARMACY AND COMPOUNDING LAB ” Practice Location

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