Provider Demographics
NPI:1821373192
Name:SPOGEN, FREDERICK CLIFFORD III (RPHCP)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:CLIFFORD
Last Name:SPOGEN
Suffix:III
Gender:M
Credentials:RPHCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 SW 42ND ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-1366
Mailing Address - Country:US
Mailing Address - Phone:352-572-0666
Mailing Address - Fax:352-873-8233
Practice Address - Street 1:1300 SW 42ND ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-1366
Practice Address - Country:US
Practice Address - Phone:352-572-0666
Practice Address - Fax:352-873-8233
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20146183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist