Provider Demographics
NPI:1306128905
Name:SCOTT, ROGER GREGORY (R PH)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:GREGORY
Last Name:SCOTT
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHERBORN
Mailing Address - State:MA
Mailing Address - Zip Code:01770-1553
Mailing Address - Country:US
Mailing Address - Phone:508-653-7770
Mailing Address - Fax:
Practice Address - Street 1:19 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SHERBORN
Practice Address - State:MA
Practice Address - Zip Code:01770-1553
Practice Address - Country:US
Practice Address - Phone:508-653-7770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH15204183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist