Provider Demographics
NPI:1265617732
Name:DAVILA, SPENCER THOMAS (RPH)
Entity type:Individual
Prefix:MR
First Name:SPENCER
Middle Name:THOMAS
Last Name:DAVILA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 HEREFORD LN
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-6606
Mailing Address - Country:US
Mailing Address - Phone:845-323-4446
Mailing Address - Fax:
Practice Address - Street 1:208 EAST ROUTE 59
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-2910
Practice Address - Country:US
Practice Address - Phone:845-352-7865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-03
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042143183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist