Provider Demographics
NPI:1447532379
Name:SCOTT, EVELYN KEEL
Entity type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:KEEL
Last Name:SCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5340 SOUTEL DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32219-3478
Mailing Address - Country:US
Mailing Address - Phone:904-764-1773
Mailing Address - Fax:904-764-3034
Practice Address - Street 1:5340 SOUTEL DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32219-3478
Practice Address - Country:US
Practice Address - Phone:904-764-1773
Practice Address - Fax:904-764-3034
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS32103183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist