Provider Demographics
NPI:1306979950
Name:SPADER, THEODORE JAMES (RPH, MSPHAD)
Entity type:Individual
Prefix:
First Name:THEODORE
Middle Name:JAMES
Last Name:SPADER
Suffix:
Gender:M
Credentials:RPH, MSPHAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 EDWARD PRIDE WYND
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-5320
Mailing Address - Country:US
Mailing Address - Phone:919-787-0017
Mailing Address - Fax:919-781-9005
Practice Address - Street 1:3432 EDWARDS MILL RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-5360
Practice Address - Country:US
Practice Address - Phone:919-781-9580
Practice Address - Fax:919-781-9005
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10028183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist