Provider Demographics
NPI:1275694341
Name:SPENCER DRUGS LTD
Entity Type:Organization
Organization Name:SPENCER DRUGS LTD
Other - Org Name:SPENCER DRUGS LTD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-439-3852
Mailing Address - Street 1:5702 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-3903
Mailing Address - Country:US
Mailing Address - Phone:718-439-3852
Mailing Address - Fax:718-439-3529
Practice Address - Street 1:5702 7TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3903
Practice Address - Country:US
Practice Address - Phone:718-439-3852
Practice Address - Fax:718-439-3529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0253933336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02281125Medicaid
2064151OtherPK
NY02281125Medicaid