Provider Demographics
NPI:1346412475
Name:SOUTHARD, SCOTT JEFFREY (RPH)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:JEFFREY
Last Name:SOUTHARD
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 1:400 COLONY BLVD
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-6086
Mailing Address - Country:US
Mailing Address - Phone:352-205-7010
Mailing Address - Fax:352-205-8951
Practice Address - Street 1:400 COLONY BLVD
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-6086
Practice Address - Country:US
Practice Address - Phone:315-622-4000
Practice Address - Fax:585-622-0250
Is Sole Proprietor?:No
Enumeration Date:2008-03-28
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048172183500000X
FLPS64186183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS64186OtherPHARMACIST LICENSE
NY048172OtherPHARMACIST LICENSE