Provider Demographics
NPI:1578984209
Name:SCOTT, LAWRENCE WILLIAM JR
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:WILLIAM
Last Name:SCOTT
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W MCKINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:HAUGHTON
Mailing Address - State:LA
Mailing Address - Zip Code:71037-9449
Mailing Address - Country:US
Mailing Address - Phone:318-949-3700
Mailing Address - Fax:318-949-3702
Practice Address - Street 1:400 W MCKINLEY AVE
Practice Address - Street 2:
Practice Address - City:HAUGHTON
Practice Address - State:LA
Practice Address - Zip Code:71037-9449
Practice Address - Country:US
Practice Address - Phone:318-949-3700
Practice Address - Fax:318-949-3702
Is Sole Proprietor?:No
Enumeration Date:2013-12-24
Last Update Date:2013-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11355183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist