Provider Demographics
NPI:1942470802
Name:ZELLEM, SCOTT S (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:S
Last Name:ZELLEM
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-5216
Mailing Address - Country:US
Mailing Address - Phone:516-378-9720
Mailing Address - Fax:516-378-0710
Practice Address - Street 1:403 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-5216
Practice Address - Country:US
Practice Address - Phone:516-378-9720
Practice Address - Fax:516-378-0710
Is Sole Proprietor?:No
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050034183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist