Provider Demographics
NPI:1437606936
Name:PRUTZMAN, SCOTT (PHARMD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:PRUTZMAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5261 HOLIDAY DRIVE
Mailing Address - Street 2:PO BOX 282
Mailing Address - City:POCONO SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18346
Mailing Address - Country:US
Mailing Address - Phone:845-741-3042
Mailing Address - Fax:
Practice Address - Street 1:27 N 7TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18101-1357
Practice Address - Country:US
Practice Address - Phone:610-437-7261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP450711183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist