MEDICARE: SCOTT WALLACE CARSON 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	1835P2201X	Ambulatory Care Pharmacist	5302413841	MI

General Provider Information

NPI Number	:	1912863580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT WALLACE CARSON PHARMD

Provider Business Mailing Address
First Line	:	2480 HOGAN WAY
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48188-6301
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2480 HOGAN WAY
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48188-6301
Country	:	US
Telephone Number	:	412-551-4725
Fax Number	:

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

Provider Enumeration Date	:	12/29/2025
Last Update Date	:	12/29/2025

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Directions to “ SCOTT WALLACE CARSON PHARMD” Practice Location

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