Provider Demographics
NPI:1003478439
Name:HARVEY, SCOTT LANE
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:LANE
Last Name:HARVEY
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 1:417 W ROCK ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BOYD
Mailing Address - State:TX
Mailing Address - Zip Code:76023-3103
Mailing Address - Country:US
Mailing Address - Phone:940-433-8056
Mailing Address - Fax:
Practice Address - Street 1:3132 OAKDALE DR
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-2008
Practice Address - Country:US
Practice Address - Phone:817-319-8879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-06
Last Update Date:2019-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33784183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist