=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548363799
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SCOTT ANDREW SPRENGER PHARM.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/06/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4102 PINION DR SUITE 100
-----------------------------------------------------
City | USAF ACADEMY
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80840-2502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-333-5290
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15837 DAWSON CREEK DR
-----------------------------------------------------
City | MONUMENT
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80132-6067
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-488-6996
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835P1200X
-----------------------------------------------------
Taxonomy Name | Pharmacotherapy Pharmacist
-----------------------------------------------------
License Number | 33261
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------