Provider Demographics
NPI:1124116298
Name:SPARTAN PHARMACY INC
Entity type:Organization
Organization Name:SPARTAN PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:412-884-5650
Mailing Address - Street 1:3400 SOUTH PARK RD
Mailing Address - Street 2:
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102
Mailing Address - Country:US
Mailing Address - Phone:412-831-1333
Mailing Address - Fax:412-831-1991
Practice Address - Street 1:3400 S PARK RD
Practice Address - Street 2:
Practice Address - City:BETHEL PARK
Practice Address - State:PA
Practice Address - Zip Code:15102-1150
Practice Address - Country:US
Practice Address - Phone:412-831-1333
Practice Address - Fax:412-831-1991
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPARTAN PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-11
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP411714L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy