Provider Demographics
NPI:1942579255
Name:SCOTT, THERESA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:
Other - Last Name:BULLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8870 W TRAVIS LN
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-8539
Mailing Address - Country:US
Mailing Address - Phone:414-333-3725
Mailing Address - Fax:
Practice Address - Street 1:5000 W CHAMBERS ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-1650
Practice Address - Country:US
Practice Address - Phone:414-447-2585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-16
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16254-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist