Provider Demographics
NPI:1033513700
Name:GULL, SPENCER J (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:J
Last Name:GULL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6810 WANDAWEGA CIR
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-8514
Mailing Address - Country:US
Mailing Address - Phone:262-617-9721
Mailing Address - Fax:
Practice Address - Street 1:6707 W HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-4833
Practice Address - Country:US
Practice Address - Phone:414-536-1179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17581-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist