Provider Demographics
NPI:1659423044
Name:SPENCER, SUSAN ELIZABETH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:SPENCER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:ELIZABETH
Other - Last Name:PATTISHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:9740B UNIVERSITY CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-3608
Mailing Address - Country:US
Mailing Address - Phone:704-688-5330
Mailing Address - Fax:704-510-4311
Practice Address - Street 1:9740B UNIVERSITY CITY BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-3608
Practice Address - Country:US
Practice Address - Phone:704-688-5330
Practice Address - Fax:704-510-4311
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist