MEDICARE: THOMAS EDWARD SPELL JR. R.PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	E-8117	MS

General Provider Information

NPI Number	:	1548229867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS EDWARD SPELL JR. R.PH.

Provider Business Mailing Address
First Line	:	PO BOX 631
Second Line	:
City	:	CRYSTAL SPRINGS
State	:	MS
Zip	:	39059-0631
Country	:	US
Telephone Number	:	601-750-0986
Fax Number	:	601-892-6055

Provider Business Practice Location Address
First Line	:	101 E GEORGETOWN ST
Second Line	:
City	:	CRYSTAL SPRINGS
State	:	MS
Zip	:	39059-2777
Country	:	US
Telephone Number	:	601-892-4061
Fax Number	:	601-892-6055

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	07/08/2007

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