Provider Demographics
NPI:1811908304
Name:SPENCE MEDICAL PHARMACY LLC
Entity type:Organization
Organization Name:SPENCE MEDICAL PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:VELA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:956-583-2700
Mailing Address - Street 1:1107 PAMELA, STE B
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572
Mailing Address - Country:US
Mailing Address - Phone:956-583-2700
Mailing Address - Fax:956-583-3220
Practice Address - Street 1:2301 E MULBERRY ST
Practice Address - Street 2:
Practice Address - City:ANGLETON
Practice Address - State:TX
Practice Address - Zip Code:77515-3804
Practice Address - Country:US
Practice Address - Phone:979-849-9391
Practice Address - Fax:979-848-0900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX194623336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148745Medicaid
4579910OtherOTHER ID NUMBER-COMMERCIAL NUMBER
TX144826Medicaid
TXPH0612Medicare PIN
4579910OtherOTHER ID NUMBER-COMMERCIAL NUMBER