Basic Information
| Provider Information | |||||||||
| NPI: | 1871185462 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SPANN | ||||||||
| FirstName: | ABIGAIL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3860 NARA DR | ||||||||
| Address2: | |||||||||
| City: | FLORISSANT | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630333221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3145803696 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3390 N HIGHWAY 67 | ||||||||
| Address2: | |||||||||
| City: | FLORISSANT | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630331605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3148240022 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2021 | ||||||||
| LastUpdateDate: | 02/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183700000X | 2017037767 | MO | Y | Pharmacy Service Providers | Pharmacy Technician |
No ID Information.