Provider Demographics
NPI:1194166025
Name:KAFADER, SCOTT ALLEN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ALLEN
Last Name:KAFADER
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 1:1150 N. ROOSEVELT DR.
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SEASIDE
Mailing Address - State:OR
Mailing Address - Zip Code:97138
Mailing Address - Country:US
Mailing Address - Phone:503-717-7150
Mailing Address - Fax:503-717-7159
Practice Address - Street 1:1150 N. ROOSEVELT DR.
Practice Address - Street 2:SUITE 104
Practice Address - City:SEASIDE
Practice Address - State:OR
Practice Address - Zip Code:97138
Practice Address - Country:US
Practice Address - Phone:503-717-7150
Practice Address - Fax:503-717-7159
Is Sole Proprietor?:No
Enumeration Date:2013-07-08
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH-604042391835P0018X
ORRPH-00135791835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist