Provider Demographics
NPI:1750675773
Name:FORLER, SCOTT
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:FORLER
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 1:474 CHAMBERLAIN HWY
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06451-1818
Mailing Address - Country:US
Mailing Address - Phone:860-694-1463
Mailing Address - Fax:
Practice Address - Street 1:250 MAIN ST APT 927
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-1877
Practice Address - Country:US
Practice Address - Phone:860-794-1463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0009486183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist