Individual
SHANE ALLEN SPACEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMACIST
Contact information
Practice address
6 ROAD 7586, BLOOMFIELD, NM 87413-4934
(505) 960-7860
Mailing address
6 ROAD 7586, BLOOMFIELD, NM 87413-4934
(505) 960-7860
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PH42212
SC
Other
Enumeration date
05/20/2020
Last updated
05/20/2020
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