Healthcare Provider Details

I. General information

NPI: 1831309749
Provider Name (Legal Business Name): DIANA JOY SPENCER PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2324 EASTLAKE AVE E STE 400
SEATTLE WA
98102-6539
US

IV. Provider business mailing address

2324 EASTLAKE AVE E STE 400
SEATTLE WA
98102-6539
US

V. Phone/Fax

Practice location:
  • Phone: 206-838-4590
  • Fax: 206-838-4599
Mailing address:
  • Phone: 206-838-4590
  • Fax: 206-838-4599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberIR00061432
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: