Provider Demographics
NPI:1457666554
Name:FONTENOT, SCOTT JAMES
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:JAMES
Last Name:FONTENOT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 ODD FELLOWS RD
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70526-2214
Mailing Address - Country:US
Mailing Address - Phone:337-783-8316
Mailing Address - Fax:337-783-8446
Practice Address - Street 1:806 ODD FELLOWS RD
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-2214
Practice Address - Country:US
Practice Address - Phone:337-783-8316
Practice Address - Fax:337-783-8446
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15634183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist