Provider Demographics
NPI:1174528855
Name:SPORE, RANAE MARIE (PHARMACY TEC)
Entity type:Individual
Prefix:
First Name:RANAE
Middle Name:MARIE
Last Name:SPORE
Suffix:
Gender:F
Credentials:PHARMACY TEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 154
Mailing Address - Street 2:
Mailing Address - City:STARBUCK
Mailing Address - State:MN
Mailing Address - Zip Code:56381-0154
Mailing Address - Country:US
Mailing Address - Phone:320-239-2246
Mailing Address - Fax:320-239-2296
Practice Address - Street 1:406 8 1/2 STREET
Practice Address - Street 2:
Practice Address - City:STARBUCK
Practice Address - State:MN
Practice Address - Zip Code:56381-0154
Practice Address - Country:US
Practice Address - Phone:320-239-2246
Practice Address - Fax:320-239-2296
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN700468-5183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician