MEDICARE: PENSLOW PHARMACY

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	333600000X	Pharmacy	05390	NC
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3425255	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881609477
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PENSLOW PHARMACY

Provider Business Mailing Address
First Line	:	PO BOX 146
Second Line	:
City	:	HOLLY RIDGE
State	:	NC
Zip	:	28445-0146
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	206 N DYSON ST
Second Line	:
City	:	HOLLY RIDGE
State	:	NC
Zip	:	28445-8502
Country	:	US
Telephone Number	:	910-329-6151
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RANDY SPAINHOOR
Credential	:
Telephone Number	:	910-324-6151

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	09/11/2025

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Directions to “PENSLOW PHARMACY ” Practice Location

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