Provider Demographics
NPI:1982039517
Name:SPOTTS, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:SPOTTS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4586 WELLS RD
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49270-9461
Mailing Address - Country:US
Mailing Address - Phone:419-343-4195
Mailing Address - Fax:
Practice Address - Street 1:21111 VAN BORN RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-1339
Practice Address - Country:US
Practice Address - Phone:313-278-2380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-13
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302025464183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist