Provider Demographics
NPI:1376694331
Name:SPICKARD, DANA (PHARMD)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:SPICKARD
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 1:11854 MARLBORO AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-9719
Mailing Address - Country:US
Mailing Address - Phone:606-260-1383
Mailing Address - Fax:
Practice Address - Street 1:11854 MARLBORO AVE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601
Practice Address - Country:US
Practice Address - Phone:606-260-1383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY012625183500000X
TX38575183500000X
OH03230075183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist