Provider Demographics
NPI:1023221827
Name:SPENCER, CLARA DAVIS (RPH)
Entity Type:Individual
Prefix:MS
First Name:CLARA
Middle Name:DAVIS
Last Name:SPENCER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2302 AVENHAM AVE SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-1606
Mailing Address - Country:US
Mailing Address - Phone:540-344-6156
Mailing Address - Fax:540-224-3001
Practice Address - Street 1:2823 FRANKLIN RD SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-1025
Practice Address - Country:US
Practice Address - Phone:540-224-0393
Practice Address - Fax:540-224-3001
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202005764183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist