Provider Demographics
NPI:1326213869
Name:SPANTGOS, NICK ANTHONY (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:NICK
Middle Name:ANTHONY
Last Name:SPANTGOS
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 SW 21ST ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-3302
Mailing Address - Country:US
Mailing Address - Phone:785-350-3724
Mailing Address - Fax:
Practice Address - Street 1:3401 SW 21ST ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-3302
Practice Address - Country:US
Practice Address - Phone:785-350-3724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-27221183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist