Provider Demographics
NPI:1801114590
Name:SPENCER, TONI FRANCESKI (RPH)
Entity type:Individual
Prefix:MRS
First Name:TONI
Middle Name:FRANCESKI
Last Name:SPENCER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06073-3000
Mailing Address - Country:US
Mailing Address - Phone:860-657-4731
Mailing Address - Fax:
Practice Address - Street 1:77 OLD BRICKYARD LN
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:CT
Practice Address - Zip Code:06037-1423
Practice Address - Country:US
Practice Address - Phone:800-282-4321
Practice Address - Fax:800-643-5093
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7437183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT7437OtherPHARMACY LICENSE