Healthcare Provider Details

I. General information

NPI: 1467905562
Provider Name (Legal Business Name): JIM B SPEARS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2016
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 HILLCREST DR
VERNON TX
76384-4099
US

IV. Provider business mailing address

P.O. BOX 1737
VERNON TX
76385
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 Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number16832
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: TERRY SPEARS
Title or Position: PRESIDENT
Credential:
Phone: 940-552-2999