Provider Demographics
NPI:1649305665
Name:CULLEY, JAMES SCOTT (RPH)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:SCOTT
Last Name:CULLEY
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 1:1826 TANGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IN
Mailing Address - Zip Code:47620-8213
Mailing Address - Country:US
Mailing Address - Phone:812-838-3484
Mailing Address - Fax:
Practice Address - Street 1:4851 W LLOYD EXPY
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47712-6520
Practice Address - Country:US
Practice Address - Phone:812-421-1268
Practice Address - Fax:812-426-7090
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26018570183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100302060AMedicaid
IN1168390002Medicare ID - Type Unspecified