Provider Demographics
NPI:1801838941
Name:SPENCER, CHARLES ERVIN (RPH)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:ERVIN
Last Name:SPENCER
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 1:1886 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29130-9657
Mailing Address - Country:US
Mailing Address - Phone:803-320-4410
Mailing Address - Fax:
Practice Address - Street 1:203 W MARION ST
Practice Address - Street 2:
Practice Address - City:KERSHAW
Practice Address - State:SC
Practice Address - Zip Code:29067-1412
Practice Address - Country:US
Practice Address - Phone:803-475-9665
Practice Address - Fax:803-475-0996
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2015-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist