Provider Demographics
NPI:1427482637
Name:SPEER, DAVID P (PHARMD)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:P
Last Name:SPEER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13736 S COUNTY LINE RD W
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:IN
Mailing Address - Zip Code:46783-9609
Mailing Address - Country:US
Mailing Address - Phone:260-638-4319
Mailing Address - Fax:260-482-3717
Practice Address - Street 1:431 FERNHILL AVE
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-1039
Practice Address - Country:US
Practice Address - Phone:260-484-4442
Practice Address - Fax:260-482-3717
Is Sole Proprietor?:No
Enumeration Date:2013-08-23
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26017349A1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
450855OtherCORAM NAPB #