Provider Demographics
NPI:1528549144
Name:CLAIBORNE, SPENSER
Entity Type:Individual
Prefix:
First Name:SPENSER
Middle Name:
Last Name:CLAIBORNE
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 1:171 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501-1351
Mailing Address - Country:US
Mailing Address - Phone:615-388-5020
Mailing Address - Fax:
Practice Address - Street 1:1261 US HIGHWAY 27 N
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:KY
Practice Address - Zip Code:40484-9750
Practice Address - Country:US
Practice Address - Phone:606-365-9191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY019874183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY019874OtherPHARMACIST LICENSE NUMBER