Provider Demographics
NPI:1871696385
Name:CLAIRMONT, SPENCER E (RPH ,FELLOW, ASCP)
Entity type:Individual
Prefix:MR
First Name:SPENCER
Middle Name:E
Last Name:CLAIRMONT
Suffix:
Gender:M
Credentials:RPH ,FELLOW, ASCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 CENTRAL AVENUE
Mailing Address - Street 2:PO BOX 428
Mailing Address - City:WALHALLA
Mailing Address - State:ND
Mailing Address - Zip Code:58282-0428
Mailing Address - Country:US
Mailing Address - Phone:701-549-2661
Mailing Address - Fax:701-549-2664
Practice Address - Street 1:1102 CENTRAL AVENUE
Practice Address - Street 2:
Practice Address - City:WALHALLA
Practice Address - State:ND
Practice Address - Zip Code:58282-0428
Practice Address - Country:US
Practice Address - Phone:701-549-2661
Practice Address - Fax:701-549-2664
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3440183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND3440OtherPHARMACIST LISCENCE NUMBE