Healthcare Provider Details

I. General information

NPI: 1184784910
Provider Name (Legal Business Name): STEVEN G SPRUILL R.PH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 BIG A RD S
TOCCOA GA
30577-3812
US

IV. Provider business mailing address

906 BIG A RD S
TOCCOA GA
30577-3812
US

V. Phone/Fax

Practice location:
  • Phone: 706-886-3119
  • Fax: 706-886-3110
Mailing address:
  • Phone: 706-886-3119
  • Fax: 706-886-3110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13357
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: