Provider Demographics
NPI:1588172043
Name:SCOTT, BARBARA JO
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:JO
Last Name:SCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 NICOLLET AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56003-3630
Mailing Address - Country:US
Mailing Address - Phone:507-317-3404
Mailing Address - Fax:
Practice Address - Street 1:1230 STATE ST N
Practice Address - Street 2:
Practice Address - City:WASECA
Practice Address - State:MN
Practice Address - Zip Code:56093-2706
Practice Address - Country:US
Practice Address - Phone:507-833-7007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-18
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN116497183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist