Provider Demographics
NPI:1962662742
Name:TULLOCH, SCOTT MACINTOSH (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:MACINTOSH
Last Name:TULLOCH
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 1:4600 COCONUT CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33063-3902
Mailing Address - Country:US
Mailing Address - Phone:954-975-0800
Mailing Address - Fax:954-975-6198
Practice Address - Street 1:4600 COCONUT CREEK PKWY
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33063-3902
Practice Address - Country:US
Practice Address - Phone:954-975-0800
Practice Address - Fax:954-975-6198
Is Sole Proprietor?:No
Enumeration Date:2008-06-15
Last Update Date:2008-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS36777183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist