Provider Demographics
NPI:1053538553
Name:SPEARS, CRAIG WOODSON
Entity type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:WOODSON
Last Name:SPEARS
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 1:177 CYNTHIAS RDG
Mailing Address - Street 2:
Mailing Address - City:FISHERVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40023-7573
Mailing Address - Country:US
Mailing Address - Phone:502-477-5313
Mailing Address - Fax:
Practice Address - Street 1:1025 NEW MOODY LN
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-9154
Practice Address - Country:US
Practice Address - Phone:502-222-3352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY007855183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist