Provider Demographics
NPI:1487022414
Name:CROOK, SPENCER R (PHARMD, MS HSPA)
Entity Type:Individual
Prefix:MR
First Name:SPENCER
Middle Name:R
Last Name:CROOK
Suffix:
Gender:M
Credentials:PHARMD, MS HSPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 S. MILLER ST.
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-3201
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:238 OLDS STATION RD.
Practice Address - Street 2:SUITE B
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-8131
Practice Address - Country:US
Practice Address - Phone:509-664-4868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-08
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60565942183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1487022414Medicaid