Provider Demographics
NPI:1740563691
Name:SPENCER, JENNIFER NICHOLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:NICHOLE
Last Name:SPENCER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 FENNEL GREEN DR
Mailing Address - Street 2:
Mailing Address - City:SEFFNER
Mailing Address - State:FL
Mailing Address - Zip Code:33584-3729
Mailing Address - Country:US
Mailing Address - Phone:813-657-3783
Mailing Address - Fax:
Practice Address - Street 1:4340 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-1631
Practice Address - Country:US
Practice Address - Phone:863-644-7549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS39675183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist