Provider Demographics
NPI:1245337187
Name:SPINDALE LONG TERM CARE PHARMACY INC
Entity type:Organization
Organization Name:SPINDALE LONG TERM CARE PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KOONCE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:828-288-1044
Mailing Address - Street 1:117 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPINDALE
Mailing Address - State:NC
Mailing Address - Zip Code:28160-1539
Mailing Address - Country:US
Mailing Address - Phone:828-288-1044
Mailing Address - Fax:828-286-8560
Practice Address - Street 1:117 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SPINDALE
Practice Address - State:NC
Practice Address - Zip Code:28160-1539
Practice Address - Country:US
Practice Address - Phone:828-288-1044
Practice Address - Fax:828-286-8560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC075013336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2068378OtherPK
NC0815406Medicaid