Basic Information
Provider Information
NPI: 1003001116
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCOTT
FirstName: LYNNETTE
MiddleName: DORTHEA
NamePrefix:  
NameSuffix:  
Credential: PHARMACIST
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 330 S STILLAGUAMISH AVE
Address2:  
City: ARLINGTON
State: WA
PostalCode: 982231642
CountryCode: US
TelephoneNumber: 3604352133
FaxNumber: 3604034122
Practice Location
Address1: 330 S STILLAGUAMISH AVE
Address2:  
City: ARLINGTON
State: WA
PostalCode: 982231642
CountryCode: US
TelephoneNumber: 3604352133
FaxNumber: 3604034122
Other Information
ProviderEnumerationDate: 09/11/2007
LastUpdateDate: 09/11/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000XPH10596WAY Pharmacy Service ProvidersPharmacist 

No ID Information.


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