MEDICARE: DR. REBECCA MILLER SPIVEY PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	37844	TN
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	0202212867	VA
3	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	RPH025979	GA

General Provider Information

NPI Number	:	1114391752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REBECCA MILLER SPIVEY PHARMD

Provider Business Mailing Address
First Line	:	2028 WESTWIND DR
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37660-3445
Country	:	US
Telephone Number	:	423-765-0441
Fax Number	:

Provider Business Practice Location Address
First Line	:	2028 WESTWIND DR
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37660-3445
Country	:	US
Telephone Number	:	423-765-0441
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2015
Last Update Date	:	11/19/2015

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