Provider Demographics
NPI:1124622394
Name:AUGHINBAUGH, SCOT WILLIAM
Entity type:Individual
Prefix:
First Name:SCOT
Middle Name:WILLIAM
Last Name:AUGHINBAUGH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:OH
Mailing Address - Zip Code:44041-1349
Mailing Address - Country:US
Mailing Address - Phone:440-466-4133
Mailing Address - Fax:440-466-3932
Practice Address - Street 1:170 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:OH
Practice Address - Zip Code:44041-1349
Practice Address - Country:US
Practice Address - Phone:440-466-4133
Practice Address - Fax:440-466-3932
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-27
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03221058183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist