Provider Demographics
NPI:1871104588
Name:DOWELL, SPENCER
Entity type:Individual
Prefix:
First Name:SPENCER
Middle Name:
Last Name:DOWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6230 AMANDE CT
Mailing Address - Street 2:
Mailing Address - City:MORADA
Mailing Address - State:CA
Mailing Address - Zip Code:95212-9423
Mailing Address - Country:US
Mailing Address - Phone:209-931-9188
Mailing Address - Fax:
Practice Address - Street 1:1360 E PACHECO BLVD
Practice Address - Street 2:
Practice Address - City:LOS BANOS
Practice Address - State:CA
Practice Address - Zip Code:93635-4938
Practice Address - Country:US
Practice Address - Phone:209-826-2796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37330183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist