Provider Demographics
NPI:1982123758
Name:SPANN, NATHAN (PHARMD - PHARMACIST)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:
Last Name:SPANN
Suffix:
Gender:M
Credentials:PHARMD - PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 W WATERWHEEL DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83703-3131
Mailing Address - Country:US
Mailing Address - Phone:208-890-8432
Mailing Address - Fax:
Practice Address - Street 1:1650 W STATE ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-4040
Practice Address - Country:US
Practice Address - Phone:208-344-8660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP7827183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist