Provider Demographics
NPI:1447520846
Name:WEBSTER, MARK SCOTT (RPH)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:SCOTT
Last Name:WEBSTER
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 1:2560 EASTLAND RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-2406
Mailing Address - Country:US
Mailing Address - Phone:352-504-6388
Mailing Address - Fax:
Practice Address - Street 1:18910 US HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-6736
Practice Address - Country:US
Practice Address - Phone:352-735-0600
Practice Address - Fax:352-735-4205
Is Sole Proprietor?:No
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS18085183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist