Provider Demographics
NPI:1114524048
Name:LAHREN, SCOTT A (RPH)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:LAHREN
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 1:14834 GATESIDE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46814-7574
Mailing Address - Country:US
Mailing Address - Phone:260-466-2326
Mailing Address - Fax:
Practice Address - Street 1:402 W PLAZA DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA CITY
Practice Address - State:IN
Practice Address - Zip Code:46725-1051
Practice Address - Country:US
Practice Address - Phone:260-244-4400
Practice Address - Fax:260-244-4708
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26016748A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist