Healthcare Provider Details

I. General information

NPI: 1730902586
Provider Name (Legal Business Name): JIM B SPEARS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2024
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 HILLCREST DR
VERNON TX
76384-4099
US

IV. Provider business mailing address

PO BOX 1737
VERNON TX
76385-1737
US

V. Phone/Fax

Practice location:
  • Phone: 940-552-2999
  • Fax: 940-552-5347
Mailing address:
  • Phone: 940-552-2999
  • Fax: 940-552-5347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ADAM BLAKE BEAM
Title or Position: VICE PRESIDENT
Credential: PHARMD
Phone: 940-552-2999