Provider Demographics
NPI:1528163193
Name:HERZOG, SCOTT DOUGLAS (PHARM D)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:DOUGLAS
Last Name:HERZOG
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12050 PINEHURST WAY NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-5108
Mailing Address - Country:US
Mailing Address - Phone:206-547-2095
Mailing Address - Fax:206-361-7453
Practice Address - Street 1:12050 PINEHURST WAY NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-5108
Practice Address - Country:US
Practice Address - Phone:206-547-2095
Practice Address - Fax:206-361-7453
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00051816183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist