Provider Demographics
NPI:1568782266
Name:SPENCER DRUG CO,, LLC
Entity Type:Organization
Organization Name:SPENCER DRUG CO,, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER/OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAYNARD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:931-212-6711
Mailing Address - Street 1:120 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:TN
Mailing Address - Zip Code:38585-3214
Mailing Address - Country:US
Mailing Address - Phone:931-946-7900
Mailing Address - Fax:931-946-8900
Practice Address - Street 1:120 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:TN
Practice Address - Zip Code:38585-3214
Practice Address - Country:US
Practice Address - Phone:931-946-7900
Practice Address - Fax:931-946-8900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-03
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy