Provider Demographics
NPI:1477156800
Name:SPENCER, MYRL D (RPH)
Entity Type:Individual
Prefix:MR
First Name:MYRL
Middle Name:D
Last Name:SPENCER
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 1:108 CHERRY HILL DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-9654
Mailing Address - Country:US
Mailing Address - Phone:859-221-8412
Mailing Address - Fax:
Practice Address - Street 1:705 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-1164
Practice Address - Country:US
Practice Address - Phone:502-863-9823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY010893183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist