Provider Demographics
NPI:1639455132
Name:SPENCER, CAROL ELAINE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:ELAINE
Last Name:SPENCER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16031 S LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-3889
Mailing Address - Country:US
Mailing Address - Phone:913-638-3175
Mailing Address - Fax:
Practice Address - Street 1:15100 W 87TH STREET PKWY
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66219-1420
Practice Address - Country:US
Practice Address - Phone:913-438-5172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13693183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist