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General NPI Number Information
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NPI Number | 1801838941
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Entity Type | Individual
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Provider Name | CHARLES ERVIN SPENCER RPH
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Gender | Male
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Dates
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Enumeration Date | 06/12/2006
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Last Update Date | 02/14/2015
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Provider Practice Location Address
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Address Line | 203 W MARION ST
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City | KERSHAW
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State | SC
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Zip | 29067-1412
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Country | US
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Telephone | 803-475-9665
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Fax | 803-475-0996
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Provider Business Mailing Address
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Address Line | 1886 LAKE RD
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City | RIDGEWAY
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State | SC
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Zip | 29130-9657
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Country | US
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Telephone | 803-320-4410
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Fax |
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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 | 4600
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License Number State | SC
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