Provider Demographics
NPI:1366727745
Name:ENOKIAN, SCOTT RICHARD (RPH)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:RICHARD
Last Name:ENOKIAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10276 BELLEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48111-1389
Mailing Address - Country:US
Mailing Address - Phone:734-697-4374
Mailing Address - Fax:734-697-4752
Practice Address - Street 1:10276 BELLEVILLE RD
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48111-1389
Practice Address - Country:US
Practice Address - Phone:734-697-4374
Practice Address - Fax:734-697-4752
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302410819183500000X
NV15846183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist