Provider Demographics
NPI:1487862611
Name:NEALY, SCOTT DAVIS (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:DAVIS
Last Name:NEALY
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 DIETZ ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-7236
Mailing Address - Country:US
Mailing Address - Phone:337-494-0718
Mailing Address - Fax:337-494-0718
Practice Address - Street 1:1508 BEGLIS PKWY
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70663-5606
Practice Address - Country:US
Practice Address - Phone:337-625-2660
Practice Address - Fax:337-625-9812
Is Sole Proprietor?:No
Enumeration Date:2007-05-20
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31721183500000X
LA11172183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist