Healthcare Provider Details

I. General information

NPI: 1497782601
Provider Name (Legal Business Name): SCOTT L COURTNEY RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3656 LOWER SAXTOWN RD
WATERLOO IL
62298-4604
US

IV. Provider business mailing address

3656 LOWER SAXTOWN RD
WATERLOO IL
62298-4604
US

V. Phone/Fax

Practice location:
  • Phone: 618-476-3370
  • Fax: 617-345-0545
Mailing address:
  • Phone: 618-476-3370
  • Fax: 617-345-0545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: