Provider Demographics
NPI:1801187034
Name:SPENKER, DAREN
Entity Type:Individual
Prefix:
First Name:DAREN
Middle Name:
Last Name:SPENKER
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 1:1227 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-3022
Mailing Address - Country:US
Mailing Address - Phone:360-575-6606
Mailing Address - Fax:360-575-6608
Practice Address - Street 1:1227 15TH AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-3022
Practice Address - Country:US
Practice Address - Phone:360-575-6606
Practice Address - Fax:360-575-6608
Is Sole Proprietor?:No
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00017666183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist