Provider Demographics
NPI:1396028049
Name:DYEN, SCOTT A (RPH)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:DYEN
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 1:5205 RED BUG LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-4911
Mailing Address - Country:US
Mailing Address - Phone:407-696-2242
Mailing Address - Fax:407-696-5697
Practice Address - Street 1:5205 RED BUG LAKE RD
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-4911
Practice Address - Country:US
Practice Address - Phone:407-696-2242
Practice Address - Fax:407-696-5697
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL32582183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist