Provider Demographics
NPI:1427806173
Name:SPILLNER, MICHAEL AUSTIN (PHARMD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:AUSTIN
Last Name:SPILLNER
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 1:1130 N LEBANON ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:IN
Mailing Address - Zip Code:46052-1759
Mailing Address - Country:US
Mailing Address - Phone:765-482-3240
Mailing Address - Fax:765-482-3351
Practice Address - Street 1:1130 N LEBANON ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-1759
Practice Address - Country:US
Practice Address - Phone:765-482-3240
Practice Address - Fax:765-482-3351
Is Sole Proprietor?:No
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26024611A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist