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NPI Code Detail

MEDICARE: SCOTT DIETZWAY

MEDICARE: SCOTT DIETZWAY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist017749LA

General Provider Information

NPI Number : 1023324977
Entity Type Code : Individual
Provider Name (Legal Business Name) : SCOTT DIETZWAY
Provider Business Mailing Address
First Line : 821 W ESPLANADE AVE
Second Line :
City : KENNER
State : LA
Zip : 70065-2758
Country : US
Telephone Number : 504-468-5479
Fax Number : 504-468-1730
Provider Business Practice Location Address
First Line : 821 W ESPLANADE AVE
Second Line :
City : KENNER
State : LA
Zip : 70065-2758
Country : US
Telephone Number : 504-468-5479
Fax Number : 504-468-1730
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2010
Last Update Date : 08/28/2010

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Directions to “ SCOTT DIETZWAY ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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