Provider Demographics
NPI:1053838029
Name:SPRADLING, THOMAS ANDREW
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ANDREW
Last Name:SPRADLING
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:PO BOX 45
Mailing Address - Street 2:
Mailing Address - City:NETTLETON
Mailing Address - State:MS
Mailing Address - Zip Code:38858-0045
Mailing Address - Country:US
Mailing Address - Phone:662-963-0162
Mailing Address - Fax:
Practice Address - Street 1:7122 WILL ROBBINS HWY
Practice Address - Street 2:
Practice Address - City:NETTLETON
Practice Address - State:MS
Practice Address - Zip Code:38858-5918
Practice Address - Country:US
Practice Address - Phone:662-963-0162
Practice Address - Fax:662-963-0165
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-29
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE14386183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist