Provider Demographics
NPI:1528242344
Name:SPANBURGH, JOHN P (RPH)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:P
Last Name:SPANBURGH
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 1:8429 PRESTWICK DR
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-9495
Mailing Address - Country:US
Mailing Address - Phone:315-682-8037
Mailing Address - Fax:
Practice Address - Street 1:315 FAYETTE ST
Practice Address - Street 2:
Practice Address - City:MANLIUS
Practice Address - State:NY
Practice Address - Zip Code:13104-1628
Practice Address - Country:US
Practice Address - Phone:315-682-6138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025346-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist