Provider Demographics
NPI:1336400746
Name:SPARTANSBURG PHARMACY LLC
Entity type:Organization
Organization Name:SPARTANSBURG PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAJEC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-654-2333
Mailing Address - Street 1:317 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SPARTANSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16434
Mailing Address - Country:US
Mailing Address - Phone:814-654-2333
Mailing Address - Fax:814-654-2334
Practice Address - Street 1:317 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPARTANSBURG
Practice Address - State:PA
Practice Address - Zip Code:16434-1057
Practice Address - Country:US
Practice Address - Phone:814-654-2333
Practice Address - Fax:814-654-2334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-01
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4822573336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3997460OtherNCPDP PROVIDER IDENTIFICATION NUMBER