Provider Demographics
NPI:1083717151
Name:SCOTT PHARMACY INC
Entity Type:Organization
Organization Name:SCOTT PHARMACY INC
Other - Org Name:SCOTT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:HEBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-235-5216
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:SCOTT
Mailing Address - State:LA
Mailing Address - Zip Code:70583-0188
Mailing Address - Country:US
Mailing Address - Phone:337-235-5216
Mailing Address - Fax:337-235-5217
Practice Address - Street 1:1000 SAINT MARY ST
Practice Address - Street 2:
Practice Address - City:SCOTT
Practice Address - State:LA
Practice Address - Zip Code:70583-5173
Practice Address - Country:US
Practice Address - Phone:337-235-5216
Practice Address - Fax:337-235-5217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2013-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
LAPHY000997IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2028317OtherPK
LA1238104Medicaid
0274150001Medicare NSC