Provider Demographics
NPI:1184784910
Name:SPRUILL, STEVEN G (RPH)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:G
Last Name:SPRUILL
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 1:906 BIG A RD S
Mailing Address - Street 2:
Mailing Address - City:TOCCOA
Mailing Address - State:GA
Mailing Address - Zip Code:30577-3812
Mailing Address - Country:US
Mailing Address - Phone:706-886-3119
Mailing Address - Fax:706-886-3110
Practice Address - Street 1:906 BIG A RD S
Practice Address - Street 2:
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577-3812
Practice Address - Country:US
Practice Address - Phone:706-886-3119
Practice Address - Fax:706-886-3110
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA13357183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0180050001Medicare ID - Type UnspecifiedMEDICARE NUMBER