Organization
CHARLES R SPIVEY, INC.
Active
Other names
Greene Super Drug
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES RAY SPIVEY R.PH. (PRESIDENT)
(334) 644-3154
Entity
Organization
Contact information
Practice address
701 N GILMER AVE, LANETT, AL 36863-2081
(334) 644-3154
(334) 644-5600
Mailing address
701 N GILMER AVE, LANETT, AL 36863-2081
(334) 644-3154
(334) 644-5600
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
104710
AL
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000135671A
—
GA
05
—
100003681
—
AL
01
—
1988802
PK
—
Enumeration date
07/30/2006
Last updated
12/26/2023
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