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General NPI Number Information
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NPI Number | 1306979950
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Entity Type | Individual
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Provider Name | THEODORE JAMES SPADER RPH., MSPHAD
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Gender | Male
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3432 EDWARDS MILL RD
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City | RALEIGH
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State | NC
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Zip | 27612-5360
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Country | US
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Telephone | 919-781-9580
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Fax | 919-781-9005
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Provider Business Mailing Address
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Address Line | 4001 EDWARD PRIDE WYND
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City | RALEIGH
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State | NC
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Zip | 27612-5320
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Country | US
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Telephone | 919-787-0017
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Fax | 919-781-9005
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 10028
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License Number State | NC
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