Provider Demographics
NPI:1689971210
Name:WOOLLEY, SPENCER D (PHARMD)
Entity Type:Individual
Prefix:
First Name:SPENCER
Middle Name:D
Last Name:WOOLLEY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 MARINE DR NW APT 237
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-3270
Mailing Address - Country:US
Mailing Address - Phone:801-898-8444
Mailing Address - Fax:
Practice Address - Street 1:3025 LANCASTER DR NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1348
Practice Address - Country:US
Practice Address - Phone:503-378-7720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-16
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX49535183500000X
OR14522183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist