Provider Demographics
NPI:1891706461
Name:SPARTAN PHARMACY INC
Entity Type:Organization
Organization Name:SPARTAN PHARMACY INC
Other - Org Name:SPARTAN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-884-4400
Mailing Address - Street 1:3526 BROWNSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15227-3116
Mailing Address - Country:US
Mailing Address - Phone:412-884-4400
Mailing Address - Fax:412-884-4402
Practice Address - Street 1:3526 BROWNSVILLE RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15227-3116
Practice Address - Country:US
Practice Address - Phone:412-884-4400
Practice Address - Fax:412-884-4402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP4811743336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019320710005Medicaid
2086332OtherPK
2086332OtherPK