Provider Demographics
NPI:1194877670
Name:SPIESE, WALTER (RPH)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:
Last Name:SPIESE
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:PO BOX 175
Mailing Address - Street 2:220 3RD AVE. NE
Mailing Address - City:LAMOURE
Mailing Address - State:ND
Mailing Address - Zip Code:58458-0175
Mailing Address - Country:US
Mailing Address - Phone:701-883-5700
Mailing Address - Fax:701-883-5531
Practice Address - Street 1:100 1ST AVE. SW
Practice Address - Street 2:
Practice Address - City:LAMOURE
Practice Address - State:ND
Practice Address - Zip Code:58458-0175
Practice Address - Country:US
Practice Address - Phone:701-883-5339
Practice Address - Fax:701-883-5531
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2974183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist