Provider Demographics
NPI:1851327290
Name:SPENCER DRUG, LLC
Entity Type:Organization
Organization Name:SPENCER DRUG, LLC
Other - Org Name:IRVINE HEALTH CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:606-723-5446
Mailing Address - Street 1:PO BOX 316
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:KY
Mailing Address - Zip Code:40336-0316
Mailing Address - Country:US
Mailing Address - Phone:606-723-5446
Mailing Address - Fax:606-723-9017
Practice Address - Street 1:905 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:KY
Practice Address - Zip Code:40336-7230
Practice Address - Country:US
Practice Address - Phone:606-723-5446
Practice Address - Fax:606-723-9017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP07289332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100053290Medicaid
KY6311590001Medicare NSC