Provider Demographics
NPI:1194887158
Name:SCOTT, LONNIE BRYAN (RPH)
Entity type:Individual
Prefix:
First Name:LONNIE
Middle Name:BRYAN
Last Name:SCOTT
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 1:272 SHORELINE DR
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-9519
Mailing Address - Country:US
Mailing Address - Phone:252-636-0236
Mailing Address - Fax:252-672-1786
Practice Address - Street 1:135 BRIDGE TOWN BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-7192
Practice Address - Country:US
Practice Address - Phone:252-636-0236
Practice Address - Fax:252-672-1786
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16423183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC16423OtherNC BOARD OF PHARMACY LIC.