Provider Demographics
NPI:1962686741
Name:SPENCER BROTHERS PHARMACY
Entity Type:Organization
Organization Name:SPENCER BROTHERS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ALFONSO
Authorized Official - Middle Name:RAMON
Authorized Official - Last Name:SOSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-203-7660
Mailing Address - Street 1:PO BOX 972433
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79997
Mailing Address - Country:US
Mailing Address - Phone:432-229-2662
Mailing Address - Fax:432-229-3212
Practice Address - Street 1:803 O'REILLY
Practice Address - Street 2:
Practice Address - City:PRESIDIO
Practice Address - State:TX
Practice Address - Zip Code:79845
Practice Address - Country:US
Practice Address - Phone:432-229-2662
Practice Address - Fax:432-229-3212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX255713336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy