# CHARLES R SPIVEY, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Greene Super Drug
- **Organization subpart:** No

## Provider details

- **NPI number:** 1558376178
- **Authorized official:** CHARLES RAY SPIVEY R.PH. (PRESIDENT)
- **Authorized official phone:** (334) 644-3154

## Contact information

- **Practice address:** 701 N GILMER AVE, LANETT, AL 36863-2081
- **Practice address phone:** (334) 644-3154
- **Practice address fax:** (334) 644-5600
- **Mailing address:** 701 N GILMER AVE, LANETT, AL 36863-2081
- **Mailing address phone:** (334) 644-3154
- **Mailing address fax:** (334) 644-5600

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 104710 | AL | Yes |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 07/30/2006
- **Last updated:** 12/26/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 000135671A | — | GA |
| 05 | — | 100003681 | — | AL |
| 01 | — | 1988802 | PK | — |