Provider Demographics
NPI:1699253229
Name:CLANCEY, SCOTT (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:CLANCEY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49900 GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:WIXOM
Mailing Address - State:MI
Mailing Address - Zip Code:48393-3308
Mailing Address - Country:US
Mailing Address - Phone:248-449-8510
Mailing Address - Fax:248-449-8565
Practice Address - Street 1:49900 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:WIXOM
Practice Address - State:MI
Practice Address - Zip Code:48393-3308
Practice Address - Country:US
Practice Address - Phone:248-449-8510
Practice Address - Fax:248-449-8565
Is Sole Proprietor?:No
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302042757183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist