Provider Demographics
NPI:1952672537
Name:DIVENEY, SCOTT ELLIS (RPH)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:ELLIS
Last Name:DIVENEY
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 1:2628 HODDAM RD
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-5873
Mailing Address - Country:US
Mailing Address - Phone:847-372-8538
Mailing Address - Fax:
Practice Address - Street 1:1400 E LAKE COOK RD
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-8217
Practice Address - Country:US
Practice Address - Phone:224-676-5370
Practice Address - Fax:224-676-5365
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051037117183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist