Provider Demographics
NPI:1124682661
Name:WEST, SCOTT CHRISTOPHER
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:CHRISTOPHER
Last Name:WEST
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 1:1005 SUTTON WAY
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5182
Mailing Address - Country:US
Mailing Address - Phone:530-272-8881
Mailing Address - Fax:530-272-6479
Practice Address - Street 1:1005 SUTTON WAY
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5182
Practice Address - Country:US
Practice Address - Phone:530-272-8881
Practice Address - Fax:530-272-6479
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA494931835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1679516421Medicaid