Provider Demographics
NPI:1427276138
Name:SPENCER, DIANA BAKER (RPH)
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:BAKER
Last Name:SPENCER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 COUNTY ROAD 533
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-8119
Mailing Address - Country:US
Mailing Address - Phone:662-462-3049
Mailing Address - Fax:
Practice Address - Street 1:410 E WALNUT ST
Practice Address - Street 2:(LOCKE DRUG STORE)
Practice Address - City:RIPLEY
Practice Address - State:MS
Practice Address - Zip Code:38663-2112
Practice Address - Country:US
Practice Address - Phone:662-837-7177
Practice Address - Fax:662-837-7719
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-07853183500000X
TN0000007396183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist