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General NPI Number Information
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NPI Number | 1528373651
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Entity Type | Individual
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Provider Name | SPENCER M RIDDLE PHARM. D.
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Gender | Male
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Dates
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Enumeration Date | 08/12/2010
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Last Update Date | 08/12/2010
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Provider Practice Location Address
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Address Line | 5125 W NORTHERN AVE
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City | GLENDALE
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State | AZ
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Zip | 85301-1402
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Country | US
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Telephone | 623-842-1289
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Fax | 623-842-0724
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Provider Business Mailing Address
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Address Line | 5125 W NORTHERN AVE
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City | GLENDALE
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State | AZ
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Zip | 85301-1402
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Country | US
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Telephone | 623-842-1289
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Fax | 623-842-0724
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | S018049
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License Number State | AZ
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