Provider Demographics
NPI:1295401461
Name:SCOTT, CHARLYNN RENEE (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:CHARLYNN
Middle Name:RENEE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:MRS
Other - First Name:CHARLYNN
Other - Middle Name:RENEE
Other - Last Name:LEAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARM D
Mailing Address - Street 1:100 FARM VW
Mailing Address - Street 2:
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645-1865
Mailing Address - Country:US
Mailing Address - Phone:551-249-2145
Mailing Address - Fax:
Practice Address - Street 1:100 FARM VW
Practice Address - Street 2:
Practice Address - City:MONTVALE
Practice Address - State:NJ
Practice Address - Zip Code:07645-1865
Practice Address - Country:US
Practice Address - Phone:551-249-2145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02985900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist