Provider Demographics
NPI:1932287448
Name:SPEARS PHARMACY INC
Entity Type:Organization
Organization Name:SPEARS PHARMACY INC
Other - Org Name:SPEARS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHCST
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SPEARS
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARMACY
Authorized Official - Phone:252-537-1146
Mailing Address - Street 1:405 BECKER DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-3301
Mailing Address - Country:US
Mailing Address - Phone:252-537-1146
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC040883336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0425322Medicaid
2068859OtherPK
NC0425322Medicaid