Healthcare Provider Details

I. General information

NPI: 1528971835
Provider Name (Legal Business Name): SPENCER STRINGHAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 CENTRAL AVE
PORTAGE IN
46368-3506
US

IV. Provider business mailing address

901 VALE PARK RD APT 3H
VALPARAISO IN
46383-2628
US

V. Phone/Fax

Practice location:
  • Phone: 219-963-7355
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26032218A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: