Provider Demographics
NPI:1669418125
Name:SCOTTS PHARMACY LLC
Entity type:Organization
Organization Name:SCOTTS PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, PIC
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:850-587-2511
Mailing Address - Street 1:6505 HIGHWAY 29 N
Mailing Address - Street 2:
Mailing Address - City:MOLINO
Mailing Address - State:FL
Mailing Address - Zip Code:32577-5276
Mailing Address - Country:US
Mailing Address - Phone:850-587-2511
Mailing Address - Fax:850-587-3169
Practice Address - Street 1:6505 HIGHWAY 29 N
Practice Address - Street 2:
Practice Address - City:MOLINO
Practice Address - State:FL
Practice Address - Zip Code:32577-5276
Practice Address - Country:US
Practice Address - Phone:850-587-2511
Practice Address - Fax:850-587-3169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH183603336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2013570OtherPK
AL100200026Medicaid
FL022416200Medicaid
FL100200026Medicaid