Provider Demographics
NPI:1700160397
Name:SPAETH, BRIANNE MAE
Entity Type:Individual
Prefix:DR
First Name:BRIANNE
Middle Name:MAE
Last Name:SPAETH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63675 E SADDLEBROOKE BLVD STE S
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85739-1297
Mailing Address - Country:US
Mailing Address - Phone:520-477-9776
Mailing Address - Fax:
Practice Address - Street 1:63675 E SADDLEBROOKE BLVD STE S
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85739-1297
Practice Address - Country:US
Practice Address - Phone:520-477-9776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-30
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS016774183500000X
NC21696183500000X
VA0202209585183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist