=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063750156
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ADRIAN EUGENE SPENCER II PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2013
-----------------------------------------------------
Last Update Date | 01/23/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 CARBON CITY RD
-----------------------------------------------------
City | MORGANTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28655-4226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-437-3833
-----------------------------------------------------
Fax | 828-433-8507
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 315 GOLF COURSE RD APT 1903
-----------------------------------------------------
City | MORGANTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28655-5206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-514-6602
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 21860
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------