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NPI Code Detail

MEDICARE: MR. SCOTT ELLIS DIVENEY RPH

MEDICARE: MR. SCOTT ELLIS DIVENEY RPH
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
1183500000XPharmacist051037117IL

General Provider Information

NPI Number : 1952672537
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. SCOTT ELLIS DIVENEY RPH
Provider Business Mailing Address
First Line : 2628 HODDAM RD
Second Line :
City : NAPERVILLE
State : IL
Zip : 60564-5873
Country : US
Telephone Number : 847-372-8538
Fax Number :
Provider Business Practice Location Address
First Line : 1400 E LAKE COOK RD
Second Line :
City : BUFFALO GROVE
State : IL
Zip : 60089-8217
Country : US
Telephone Number : 224-676-5370
Fax Number : 224-676-5365
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/13/2012
Last Update Date : 01/13/2012

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