Provider Demographics
NPI:1346347283
Name:SPINDALE DRUG CO INC
Entity Type:Organization
Organization Name:SPINDALE DRUG CO INC
Other - Org Name:SPINDALE DRUG COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KOONCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-286-3746
Mailing Address - Street 1:109 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPINDALE
Mailing Address - State:NC
Mailing Address - Zip Code:28160-1539
Mailing Address - Country:US
Mailing Address - Phone:828-286-3746
Mailing Address - Fax:828-286-8509
Practice Address - Street 1:109 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SPINDALE
Practice Address - State:NC
Practice Address - Zip Code:28160-1539
Practice Address - Country:US
Practice Address - Phone:828-286-3746
Practice Address - Fax:828-286-8509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC01499332B00000X
333600000X
NC028973336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3411206OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NC0815159Medicaid
3411206OtherNCPDP PROVIDER IDENTIFICATION NUMBER