Provider Demographics
NPI:1043667439
Name:SPIVEY, SAMUEL (RPH)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:SPIVEY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4505 FALLS OF NEUSE RD
Mailing Address - Street 2:SUITE 550
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6277
Mailing Address - Country:US
Mailing Address - Phone:919-674-3660
Mailing Address - Fax:888-502-5946
Practice Address - Street 1:4505 FALLS OF NEUSE RD
Practice Address - Street 2:SUITE 550
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6277
Practice Address - Country:US
Practice Address - Phone:919-674-3660
Practice Address - Fax:888-502-5946
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10294183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist