Healthcare Provider Details

I. General information

NPI: 1548229867
Provider Name (Legal Business Name): THOMAS EDWARD SPELL JR. R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E GEORGETOWN ST
CRYSTAL SPRINGS MS
39059-2777
US

IV. Provider business mailing address

PO BOX 631
CRYSTAL SPRINGS MS
39059-0631
US

V. Phone/Fax

Practice location:
  • Phone: 601-892-4061
  • Fax: 601-892-6055
Mailing address:
  • Phone: 601-750-0986
  • Fax: 601-892-6055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE-8117
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: