Provider Demographics
NPI:1922447150
Name:SPIKES, CARLOS DAVID
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:DAVID
Last Name:SPIKES
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 1:3742 SW COQUINA COVE WAY APT 106
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-8179
Mailing Address - Country:US
Mailing Address - Phone:772-220-9559
Mailing Address - Fax:772-220-9559
Practice Address - Street 1:1891 N US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34946-1449
Practice Address - Country:US
Practice Address - Phone:772-461-7049
Practice Address - Fax:772-461-7029
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0017725183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist