Provider Demographics
NPI:1639451529
Name:MONTGOMERY, SCOTT W (RPH)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:W
Last Name:MONTGOMERY
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 1:2455 LEECHBURG RD
Mailing Address - Street 2:
Mailing Address - City:NEW KENSINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15068-4619
Mailing Address - Country:US
Mailing Address - Phone:724-334-1852
Mailing Address - Fax:724-334-6831
Practice Address - Street 1:2455 LEECHBURG RD
Practice Address - Street 2:
Practice Address - City:NEW KENSINGTON
Practice Address - State:PA
Practice Address - Zip Code:15068-4619
Practice Address - Country:US
Practice Address - Phone:724-334-1852
Practice Address - Fax:724-334-6831
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP041814L183500000X
WVRP0005940183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist