Provider Demographics
NPI:1942482443
Name:EAGELTON, SCOTT C (RP)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:C
Last Name:EAGELTON
Suffix:
Gender:M
Credentials:RP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BAYSHORE PLZ
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC HIGHLANDS
Mailing Address - State:NJ
Mailing Address - Zip Code:07716-1109
Mailing Address - Country:US
Mailing Address - Phone:732-291-2900
Mailing Address - Fax:
Practice Address - Street 1:2 BAYSHORE PLZ
Practice Address - Street 2:
Practice Address - City:ATLANTIC HIGHLANDS
Practice Address - State:NJ
Practice Address - Zip Code:07716-1109
Practice Address - Country:US
Practice Address - Phone:732-291-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01562800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist