Spencer Provan, RPH

NPI #1245511286 in Lake Placid, Florida

Provider Information

NPI Number: 1245511286
Entity Type: Individual
Name: Spencer Provan, RPH
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Pharmacist
Credential: RPH
Enumeration Date: Sep 5, 2011
Last Updated: Sep 5, 2011

Practice Location

Address: 1208 DRISCOLL DR
City: Lake Placid
State: Florida
ZIP Code: 33852-9647
Phone: (863) 385-9929

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pharmacist	183500000X	Primary

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