Provider Demographics
NPI:1851833891
Name:SPIO, KOJO
Entity Type:Individual
Prefix:
First Name:KOJO
Middle Name:
Last Name:SPIO
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 1:1106 VETERANS PKWY
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47129-2370
Mailing Address - Country:US
Mailing Address - Phone:812-285-1741
Mailing Address - Fax:
Practice Address - Street 1:1106 VETERANS PARKWAY
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129
Practice Address - Country:US
Practice Address - Phone:812-285-1741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY018857183500000X
IN26026859A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN4030078946OtherINDIANA STATE DRIVER'S LICENSE