Healthcare Provider Details

I. General information

NPI: 1134332885
Provider Name (Legal Business Name): CLINTON SPAAR III RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 COURT ST CHESHIRE MEDICAL CENTER
KEENE NH
03431-1718
US

IV. Provider business mailing address

580 COURT ST
KEENE NH
03431-1718
US

V. Phone/Fax

Practice location:
  • Phone: 603-354-6548
  • Fax: 603-354-6547
Mailing address:
  • Phone: 603-354-6548
  • Fax: 603-354-6547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberR1169
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: