Provider Demographics
NPI:1194015271
Name:SPENCE, MARK T, (DPH)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:T,
Last Name:SPENCE
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 S LOWRY ST
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-3007
Mailing Address - Country:US
Mailing Address - Phone:615-459-5750
Mailing Address - Fax:
Practice Address - Street 1:233 S LOWRY ST
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-3007
Practice Address - Country:US
Practice Address - Phone:615-459-5750
Practice Address - Fax:615-223-7993
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-11
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7052183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist