Provider Demographics
NPI:1528200573
Name:SPENCER, DONALD C
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:C
Last Name:SPENCER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5280 N HURON RD
Mailing Address - Street 2:
Mailing Address - City:OSCODA
Mailing Address - State:MI
Mailing Address - Zip Code:48750-9560
Mailing Address - Country:US
Mailing Address - Phone:989-739-4255
Mailing Address - Fax:989-739-3538
Practice Address - Street 1:5280 N HURON RD
Practice Address - Street 2:
Practice Address - City:OSCODA
Practice Address - State:MI
Practice Address - Zip Code:48750-9560
Practice Address - Country:US
Practice Address - Phone:989-739-4255
Practice Address - Fax:989-739-3538
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302026435183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist