Provider Demographics
NPI:1801128210
Name:SCOTT, JEFFREY JAMES
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:JAMES
Last Name:SCOTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3035 NIAGARA FALLS BLVD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-1600
Mailing Address - Country:US
Mailing Address - Phone:716-515-0030
Mailing Address - Fax:716-515-2199
Practice Address - Street 1:3035 NIAGARA FALLS BLVD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-1600
Practice Address - Country:US
Practice Address - Phone:716-515-0030
Practice Address - Fax:716-515-2199
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049076183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist