Provider Demographics
NPI:1205806080
Name:SPOON, STANTON R (RPH FASCP)
Entity type:Individual
Prefix:MR
First Name:STANTON
Middle Name:R
Last Name:SPOON
Suffix:
Gender:M
Credentials:RPH FASCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1559 WILLIAMS RD
Mailing Address - Street 2:
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-1908
Mailing Address - Country:US
Mailing Address - Phone:215-499-5166
Mailing Address - Fax:215-781-6022
Practice Address - Street 1:2522 PEARL BUCK RD
Practice Address - Street 2:UNIT A
Practice Address - City:BRISTOL
Practice Address - State:PA
Practice Address - Zip Code:19007-6809
Practice Address - Country:US
Practice Address - Phone:215-785-6616
Practice Address - Fax:215-781-6022
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP-029685-L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP-029685-LOtherPHARMACIST LICENSE