Provider Demographics
NPI:1316024805
Name:STRACENER, SCOTT WAYNE (PHARM D)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:WAYNE
Last Name:STRACENER
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:DR
Other - First Name:SCOTT
Other - Middle Name:WAYNE
Other - Last Name:STRACENER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARM D
Mailing Address - Street 1:13 SAVANNAH CT
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-7802
Mailing Address - Country:US
Mailing Address - Phone:501-350-6975
Mailing Address - Fax:
Practice Address - Street 1:4300 W 7TH ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5446
Practice Address - Country:US
Practice Address - Phone:501-257-6338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR09206183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist