Provider Demographics
NPI:1265109326
Name:SPANN, EILEEN PAMELA (PHARMD)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:PAMELA
Last Name:SPANN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 38
Mailing Address - Street 2:
Mailing Address - City:COMO
Mailing Address - State:CO
Mailing Address - Zip Code:80432-0038
Mailing Address - Country:US
Mailing Address - Phone:781-760-3413
Mailing Address - Fax:
Practice Address - Street 1:1008 N SUMMIT BLVD
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443-5048
Practice Address - Country:US
Practice Address - Phone:970-668-9980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2024-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.0023660183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist