Provider Demographics
NPI:1124746276
Name:SCOTT, JAHKEL (PHARMD)
Entity type:Individual
Prefix:
First Name:JAHKEL
Middle Name:
Last Name:SCOTT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 SUNLAND DR
Mailing Address - Street 2:
Mailing Address - City:BEEBE
Mailing Address - State:AR
Mailing Address - Zip Code:72012-3400
Mailing Address - Country:US
Mailing Address - Phone:901-651-8668
Mailing Address - Fax:
Practice Address - Street 1:1325 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-2458
Practice Address - Country:US
Practice Address - Phone:501-941-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD16289183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist