Provider Demographics
NPI:1649750639
Name:REED, SPENCER LOUIS
Entity Type:Individual
Prefix:
First Name:SPENCER
Middle Name:LOUIS
Last Name:REED
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 1:2006 BRIARCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-4126
Mailing Address - Country:US
Mailing Address - Phone:217-652-5457
Mailing Address - Fax:
Practice Address - Street 1:3501 COURT ST
Practice Address - Street 2:
Practice Address - City:CATLETTSBURG
Practice Address - State:KY
Practice Address - Zip Code:41129-1011
Practice Address - Country:US
Practice Address - Phone:606-739-4432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-19
Last Update Date:2018-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY020090183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist