Provider Demographics
NPI:1285962027
Name:SCOTT, CHARLES W III
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:W
Last Name:SCOTT
Suffix:III
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:RDI CARE PROJECT/GARDAWORLD PHARMACY
Mailing Address - Street 2:20751 CONSTITUTION AVE
Mailing Address - City:FORT BLISS
Mailing Address - State:TX
Mailing Address - Zip Code:79918
Mailing Address - Country:US
Mailing Address - Phone:979-248-8296
Mailing Address - Fax:915-328-3242
Practice Address - Street 1:RDI CARE PROJECT/GARDAWORLD PHARMACY
Practice Address - Street 2:20751 CONSTITUTION AVE
Practice Address - City:FORT BLISS
Practice Address - State:TX
Practice Address - Zip Code:79918-7991
Practice Address - Country:US
Practice Address - Phone:979-248-8296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-04
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22933183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist