Provider Demographics
NPI:1093799769
Name:MYLROIE, SCOTT CHARLES (RPH, CCP)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:CHARLES
Last Name:MYLROIE
Suffix:
Gender:M
Credentials:RPH, CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 STATE ROUTE 28
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-2471
Mailing Address - Country:US
Mailing Address - Phone:908-526-8375
Mailing Address - Fax:
Practice Address - Street 1:100 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08835-1358
Practice Address - Country:US
Practice Address - Phone:908-575-8903
Practice Address - Fax:908-575-8903
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01939800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist