Provider Demographics
NPI:1154669471
Name:SEARS, SCOTTY (RPH)
Entity Type:Individual
Prefix:
First Name:SCOTTY
Middle Name:
Last Name:SEARS
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 1:1800 OLD BLUEGRASS AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40215-1168
Mailing Address - Country:US
Mailing Address - Phone:502-361-2301
Mailing Address - Fax:502-375-0530
Practice Address - Street 1:1800 OLD BLUEGRASS AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1168
Practice Address - Country:US
Practice Address - Phone:502-361-2301
Practice Address - Fax:502-375-0530
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-21
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26024436A183500000X
KY0011099183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY011099OtherKENTUCKY BOARD OF PHARMACY
IN26024436AOtherINDIANA PROFESSIONAL LICENSING AGENCY