Provider Demographics
NPI:1902392475
Name:SPRUILL, SHANDI (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:SHANDI
Middle Name:
Last Name:SPRUILL
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E ANDERSON LN APT 213U
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-1205
Mailing Address - Country:US
Mailing Address - Phone:254-644-8345
Mailing Address - Fax:
Practice Address - Street 1:2508 E RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78741-3037
Practice Address - Country:US
Practice Address - Phone:512-448-3353
Practice Address - Fax:512-912-1377
Is Sole Proprietor?:No
Enumeration Date:2018-07-07
Last Update Date:2018-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62674183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist