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NPI Code Detail

MEDICARE: ROGER THEODORE SPEAR PHARMD

MEDICARE: ROGER THEODORE SPEAR PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist13460-040WI

General Provider Information

NPI Number : 1942298351
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROGER THEODORE SPEAR PHARMD
Provider Business Mailing Address
First Line : 1320 WISCONSIN AVE
Second Line :
City : RACINE
State : WI
Zip : 53403-1978
Country : US
Telephone Number : 262-687-8884
Fax Number : 262-687-2836
Provider Business Practice Location Address
First Line : 1320 WISCONSIN AVE
Second Line : PAIN MANAGEMENT PROGRAM
City : RACINE
State : WI
Zip : 53403-1978
Country : US
Telephone Number : 262-687-8884
Fax Number : 262-687-2836
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2005
Last Update Date : 07/08/2007

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Directions to “ ROGER THEODORE SPEAR PHARMD” Practice Location

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