Basic Information
Provider Information | |||||||||
NPI: | 1952789083 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SCOTT | ||||||||
FirstName: | AGNES | ||||||||
MiddleName: | HALSTED | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | HALSTED | ||||||||
OtherFirstName: | AGNES | ||||||||
OtherMiddleName: | ANN | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | RPH | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1100 TUNNEL RD | ||||||||
Address2: | ATTN: PHARMACY | ||||||||
City: | ASHEVILLE | ||||||||
State: | NC | ||||||||
PostalCode: | 288052576 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8282987911 | ||||||||
FaxNumber: | 8282995980 | ||||||||
Practice Location | |||||||||
Address1: | 1100 TUNNEL RD | ||||||||
Address2: | ATTN: PHARMACY | ||||||||
City: | ASHEVILLE | ||||||||
State: | NC | ||||||||
PostalCode: | 288052576 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8282987911 | ||||||||
FaxNumber: | 8282995980 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/08/2015 | ||||||||
LastUpdateDate: | 05/08/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 20046 | NC | N |   | Pharmacy Service Providers | Pharmacist |   | 183500000X | 30234 | TX | Y |   | Pharmacy Service Providers | Pharmacist |   | 183500000X | 43555 | CA | N |   | Pharmacy Service Providers | Pharmacist |   | 183500000X | 00007905 | NM | N |   | Pharmacy Service Providers | Pharmacist |   |
No ID Information.