Provider Demographics
NPI:1700065695
Name:SPETH, MARK A (RPH)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:A
Last Name:SPETH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1160 E SAINT CLAIR ST
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-4853
Mailing Address - Country:US
Mailing Address - Phone:812-882-1064
Mailing Address - Fax:812-882-4004
Practice Address - Street 1:1160 E SAINT CLAIR ST
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-4853
Practice Address - Country:US
Practice Address - Phone:812-882-1064
Practice Address - Fax:812-882-4004
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26014892A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist