Provider Demographics
NPI:1093186017
Name:SPANN, MISTI (PHARMD)
Entity Type:Individual
Prefix:
First Name:MISTI
Middle Name:
Last Name:SPANN
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 1:6501 RED HOOK PLZ
Mailing Address - Street 2:#201
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00802-1373
Mailing Address - Country:US
Mailing Address - Phone:785-218-8518
Mailing Address - Fax:
Practice Address - Street 1:6501 RED HOOK PLZ
Practice Address - Street 2:#201
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-1373
Practice Address - Country:US
Practice Address - Phone:785-218-8518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI348183500000X
KS1-16862183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist