Provider Demographics
NPI:1750924700
Name:DUCKWORTH, SPENCER JORDAN (PHARM D)
Entity type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:JORDAN
Last Name:DUCKWORTH
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12050 N DOVE MOUNTAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85658-4211
Mailing Address - Country:US
Mailing Address - Phone:520-225-0770
Mailing Address - Fax:
Practice Address - Street 1:12050 N DOVE MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:MARANA
Practice Address - State:AZ
Practice Address - Zip Code:85658-4211
Practice Address - Country:US
Practice Address - Phone:520-225-0770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-22
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS024349183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist