Provider Demographics
NPI:1548544893
Name:PLACEK, SCOTT JAMES (PHARMD)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:JAMES
Last Name:PLACEK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 BAYBERRY MEADOWS CT
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-4191
Mailing Address - Country:US
Mailing Address - Phone:636-928-1625
Mailing Address - Fax:
Practice Address - Street 1:48 PLAZA NINETY-FOUR DRIVE
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376
Practice Address - Country:US
Practice Address - Phone:636-928-1625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006025283183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist