Provider Demographics
NPI:1235125360
Name:SPENCER'S DRUG STORE, INC.
Entity Type:Organization
Organization Name:SPENCER'S DRUG STORE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANKLIN
Authorized Official - Middle Name:DELANO
Authorized Official - Last Name:YANCEY
Authorized Official - Suffix:SR
Authorized Official - Credentials:RPH
Authorized Official - Phone:434-292-3132
Mailing Address - Street 1:100 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLACKSTONE
Mailing Address - State:VA
Mailing Address - Zip Code:23824-1424
Mailing Address - Country:US
Mailing Address - Phone:434-292-3132
Mailing Address - Fax:434-292-6467
Practice Address - Street 1:100 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BLACKSTONE
Practice Address - State:VA
Practice Address - Zip Code:23824-1424
Practice Address - Country:US
Practice Address - Phone:434-292-3132
Practice Address - Fax:434-292-6467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0201000758332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0752820001Medicare ID - Type UnspecifiedDURABLE MEDICAL EQUIPMENT