Provider Demographics
NPI:1760881783
Name:BALDELLI, SCOTT WILSON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:WILSON
Last Name:BALDELLI
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 1:1806 JULIA ST
Mailing Address - Street 2:
Mailing Address - City:RAYVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71269-5560
Mailing Address - Country:US
Mailing Address - Phone:318-728-5917
Mailing Address - Fax:318-728-6675
Practice Address - Street 1:1806 JULIA ST
Practice Address - Street 2:
Practice Address - City:RAYVILLE
Practice Address - State:LA
Practice Address - Zip Code:71269-5560
Practice Address - Country:US
Practice Address - Phone:318-728-5917
Practice Address - Fax:318-728-6675
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019843183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist