Provider Demographics
NPI:1770664658
Name:SPEARS, LARRY O'NEAL (RPH)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:O'NEAL
Last Name:SPEARS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 LIVE OAK PL
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-3256
Mailing Address - Country:US
Mailing Address - Phone:252-535-2418
Mailing Address - Fax:252-537-1147
Practice Address - Street 1:405 BECKER DR
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-3301
Practice Address - Country:US
Practice Address - Phone:252-537-1146
Practice Address - Fax:252-537-1147
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC06389183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0425322Medicaid
NC0425322Medicaid