Provider Demographics
NPI:1477869469
Name:SPURLIN, PHYLLIS REYNOLDS (R,PH)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:REYNOLDS
Last Name:SPURLIN
Suffix:
Gender:F
Credentials:R,PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 WOLFORD AVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:KY
Mailing Address - Zip Code:42539-3452
Mailing Address - Country:US
Mailing Address - Phone:606-787-4236
Mailing Address - Fax:
Practice Address - Street 1:671 WOLFORD AVE
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:KY
Practice Address - Zip Code:42539-3452
Practice Address - Country:US
Practice Address - Phone:606-787-4236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY009910183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY009910OtherKY LICENSE NUMBER