Provider Demographics
NPI:1861560674
Name:SCARBROUGH, DENNIS MICHEAL (R PH)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:MICHEAL
Last Name:SCARBROUGH
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 1:7900 103RD ST
Mailing Address - Street 2:SUITE 14
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-6681
Mailing Address - Country:US
Mailing Address - Phone:904-772-8998
Mailing Address - Fax:904-772-1979
Practice Address - Street 1:7900 103RD ST
Practice Address - Street 2:SUITE 14
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-6681
Practice Address - Country:US
Practice Address - Phone:904-772-8998
Practice Address - Fax:904-772-1979
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH0012202183500000X
FLPS0014929183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1069144OtherNABP
FL1069144OtherNABP