Provider Demographics
NPI:1518630805
Name:SMITH, SCOTT SULLINS JR (PHARMD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:SULLINS
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 GREEN CEDAR DR
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-3965
Mailing Address - Country:US
Mailing Address - Phone:832-425-7010
Mailing Address - Fax:
Practice Address - Street 1:5200 FAIRMONT PKWY
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-3802
Practice Address - Country:US
Practice Address - Phone:281-487-8091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-01
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68745183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist