Healthcare Provider Details

I. General information

NPI: 1821373192
Provider Name (Legal Business Name): FREDERICK CLIFFORD SPOGEN III RPHCP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2011
Last Update Date: 10/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 SW 42ND ST
OCALA FL
34471-1366
US

IV. Provider business mailing address

1300 SW 42ND ST
OCALA FL
34471-1366
US

V. Phone/Fax

Practice location:
  • Phone: 352-572-0666
  • Fax: 352-873-8233
Mailing address:
  • Phone: 352-572-0666
  • Fax: 352-873-8233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20146
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: