Provider Demographics
NPI:1992396584
Name:ANSPACH, ERIC LEE (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:LEE
Last Name:ANSPACH
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15846 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:ELLISVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2208
Mailing Address - Country:US
Mailing Address - Phone:636-527-6074
Mailing Address - Fax:
Practice Address - Street 1:15846 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:ELLISVILLE
Practice Address - State:MO
Practice Address - Zip Code:63011-2208
Practice Address - Country:US
Practice Address - Phone:636-527-6074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO029492183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist