Provider Demographics
NPI:1154737518
Name:SPIVEY, JUSTIN
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:SPIVEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 SIDNEY CHERRY GROVE RD
Mailing Address - Street 2:
Mailing Address - City:CLARENDON
Mailing Address - State:NC
Mailing Address - Zip Code:28432-9375
Mailing Address - Country:US
Mailing Address - Phone:910-625-6459
Mailing Address - Fax:
Practice Address - Street 1:171 SIDNEY CHERRY GROVE RD
Practice Address - Street 2:
Practice Address - City:CLARENDON
Practice Address - State:NC
Practice Address - Zip Code:28432-9375
Practice Address - Country:US
Practice Address - Phone:910-625-6459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC225841835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy