Provider Demographics
NPI:1063595379
Name:AUSTIN, SPENCER JOE (RPH)
Entity type:Individual
Prefix:MR
First Name:SPENCER
Middle Name:JOE
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 PIPER RD
Mailing Address - Street 2:
Mailing Address - City:HASLETT
Mailing Address - State:MI
Mailing Address - Zip Code:48840-9793
Mailing Address - Country:US
Mailing Address - Phone:517-339-6374
Mailing Address - Fax:
Practice Address - Street 1:1100 W SAGINAW ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48915-1925
Practice Address - Country:US
Practice Address - Phone:517-364-7474
Practice Address - Fax:517-364-7475
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302021617183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist