Provider Demographics
NPI:1407925423
Name:SPITZNAGLE, PHILIP JOHN (RPH)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:JOHN
Last Name:SPITZNAGLE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 SE CRESCENT ST
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-3411
Mailing Address - Country:US
Mailing Address - Phone:816-246-7300
Mailing Address - Fax:816-875-1015
Practice Address - Street 1:937 NE WOODS CHAPEL RD
Practice Address - Street 2:PRICE CHOPPER PHARMACY
Practice Address - City:LEE'S SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064
Practice Address - Country:US
Practice Address - Phone:816-246-7300
Practice Address - Fax:816-875-1015
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO042838183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO042838OtherSTATE PHARMACY LICENSE