Provider Demographics
NPI:1356973895
Name:SPENCER, NICOLE ANDREA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:ANDREA
Last Name:SPENCER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 SANDSTONE CT
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47711-7746
Mailing Address - Country:US
Mailing Address - Phone:812-550-4668
Mailing Address - Fax:
Practice Address - Street 1:1115 AMERICAN WAY
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47601-8604
Practice Address - Country:US
Practice Address - Phone:812-897-0089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26024415A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist