Provider Demographics
NPI:1154833150
Name:SPINNEY, IAN MICHAEL
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:MICHAEL
Last Name:SPINNEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 JOHNSTON ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3263
Mailing Address - Country:US
Mailing Address - Phone:337-234-0197
Mailing Address - Fax:
Practice Address - Street 1:920 W GLORIA SWITCH RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70507
Practice Address - Country:US
Practice Address - Phone:337-896-0128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-30
Last Update Date:2018-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA022249183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist