=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326456971
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ZACHARY SPURLIN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2014
-----------------------------------------------------
Last Update Date | 07/28/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1201 S BETHLEHEM PIKE
-----------------------------------------------------
City | AMBLER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19002-5804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-646-8351
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 311 PRIMROSE DR
-----------------------------------------------------
City | UPPER GWYNEDD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19446-5692
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
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 | RP448878
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------