Healthcare Provider Details

I. General information

NPI: 1568782266
Provider Name (Legal Business Name): SPENCER DRUG CO,, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2010
Last Update Date: 08/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 COLLEGE ST
SPENCER TN
38585-3214
US

IV. Provider business mailing address

120 COLLEGE ST
SPENCER TN
38585-3214
US

V. Phone/Fax

Practice location:
  • Phone: 931-946-7900
  • Fax: 931-946-8900
Mailing address:
  • Phone: 931-946-7900
  • Fax: 931-946-8900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RHONDA A MAYNARD
Title or Position: PHARMACY MANAGER/OFFICER
Credential: PHARM. D.
Phone: 931-212-6711