Provider Demographics
NPI:1083069660
Name:SCOTT, GEORGE (RPH)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:SCOTT
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 1:1930 LAND O LAKES BLVD
Mailing Address - Street 2:15
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-2999
Mailing Address - Country:US
Mailing Address - Phone:813-948-4500
Mailing Address - Fax:813-948-0400
Practice Address - Street 1:1930 LAND O LAKES BLVD
Practice Address - Street 2:15
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-2999
Practice Address - Country:US
Practice Address - Phone:813-948-4500
Practice Address - Fax:813-948-0400
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS10663183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist