Provider Demographics
NPI:1780967299
Name:SCOTT, NICOLE K (PHARM D)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:K
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 S FASHION BLVD
Mailing Address - Street 2:
Mailing Address - City:HAHNVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70057-2004
Mailing Address - Country:US
Mailing Address - Phone:985-308-0792
Mailing Address - Fax:
Practice Address - Street 1:12589 AIRLINE HWY
Practice Address - Street 2:
Practice Address - City:DESTREHAN
Practice Address - State:LA
Practice Address - Zip Code:70047-2501
Practice Address - Country:US
Practice Address - Phone:985-764-1158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA017430183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist