Provider Demographics
NPI:1053651166
Name:SPENCER, AMY (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 N. 18TH STREET
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52544
Mailing Address - Country:US
Mailing Address - Phone:641-856-3832
Mailing Address - Fax:
Practice Address - Street 1:609 N. 18TH STREET
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:IA
Practice Address - Zip Code:52544
Practice Address - Country:US
Practice Address - Phone:641-856-3832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-26
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19957183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist