Provider Demographics
NPI:1093352254
Name:SPEAR, RIAN WILLIAM (PHARMD)
Entity Type:Individual
Prefix:
First Name:RIAN
Middle Name:WILLIAM
Last Name:SPEAR
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 1:1650 MCCULLOCH BLVD N
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-0961
Mailing Address - Country:US
Mailing Address - Phone:928-855-9200
Mailing Address - Fax:928-855-9664
Practice Address - Street 1:1650 MCCULLOCH BLVD N
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-0961
Practice Address - Country:US
Practice Address - Phone:928-855-9200
Practice Address - Fax:928-855-9664
Is Sole Proprietor?:No
Enumeration Date:2019-12-06
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS024350183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist