Provider Demographics
NPI:1568747863
Name:SPENCER, THOMAS FLOYD (PHARM D)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:FLOYD
Last Name:SPENCER
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2539 W TIMBERLAKE LOOP
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-9757
Mailing Address - Country:US
Mailing Address - Phone:954-895-0284
Mailing Address - Fax:
Practice Address - Street 1:335 W APPLEWAY AVE
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-9306
Practice Address - Country:US
Practice Address - Phone:208-765-1254
Practice Address - Fax:208-765-1303
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP6342183500000X
WAPH 60118943183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist