Provider Demographics
NPI:1174950885
Name:SCAMFER, OTTO (RPH)
Entity type:Individual
Prefix:
First Name:OTTO
Middle Name:
Last Name:SCAMFER
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 1:757 HAGGEN DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233-3328
Mailing Address - Country:US
Mailing Address - Phone:360-814-1561
Mailing Address - Fax:360-814-1595
Practice Address - Street 1:757 HAGGEN DR
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-3328
Practice Address - Country:US
Practice Address - Phone:360-814-1561
Practice Address - Fax:360-814-1595
Is Sole Proprietor?:No
Enumeration Date:2013-09-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00016412183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist