Provider Demographics
NPI:1760931364
Name:SPENCER PHARMACEUTICAL GROUP LLC
Entity Type:Organization
Organization Name:SPENCER PHARMACEUTICAL GROUP LLC
Other - Org Name:HONEOYE FALLS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-624-2000
Mailing Address - Street 1:166 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HONEOYE FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14472-1148
Mailing Address - Country:US
Mailing Address - Phone:585-624-2000
Mailing Address - Fax:585-624-2009
Practice Address - Street 1:166 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HONEOYE FALLS
Practice Address - State:NY
Practice Address - Zip Code:14472-1148
Practice Address - Country:US
Practice Address - Phone:585-624-2000
Practice Address - Fax:585-624-2009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-25
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0349973336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04611996Medicaid
2164358OtherPK