=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265109326
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EILEEN PAMELA SPANN PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/26/2021
-----------------------------------------------------
Last Update Date | 12/29/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1008 N SUMMIT BLVD
-----------------------------------------------------
City | FRISCO
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80443-5048
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-668-9980
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 38
-----------------------------------------------------
City | COMO
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80432-0038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-760-3413
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PHA.0023660
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------