Provider Demographics
NPI:1033488135
Name:VANVLYMEN, SCOTT (RPH)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:
Last Name:VANVLYMEN
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 1:5230 W 1000 N
Mailing Address - Street 2:
Mailing Address - City:WHEATFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46392-7635
Mailing Address - Country:US
Mailing Address - Phone:219-987-5435
Mailing Address - Fax:
Practice Address - Street 1:308 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:IN
Practice Address - Zip Code:46341-8790
Practice Address - Country:US
Practice Address - Phone:219-996-2930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26015985A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist