NPIMap

Organization Active NPI

Spencer Drug LLC

  • Community/Retail Pharmacy
  • Irvine, KY
National Provider Identifier
1316975923
Registry record updated Jun 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
P07407 Issued in KY
Legal business name
SPENCER DRUG LLC
Doing business as
Estill Clinic Pharmacy
Practice address
275 Court St
Irvine, KY 40336-1077
Phone
(606) 723-0044
Fax
(606) 723-0054
NPI assigned
Jun 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
John Spencer, RPH
Title
Owner and Pic
Phone
(606) 723-5446

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X P07407 KY Primary

Addresses

Primary practice location

275 Court St
Irvine, KY 40336-1077

Mailing address

275 Court St
Irvine, KY 40336-1077
Phone (606) 723-0044

Other identifiers 2

IdentifierTypeStateIssuer
71001235310MedicaidKY
2126015OtherPK

Other names 1

  • Estill Clinic Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110505000145 KY DME Supplier - Pharmacy 9032319892 Practice locations: Irvine, KY
O20110527000176 KY Part B Supplier - Mass Immunization (Roster Biller Only) 9032319892 Practice locations: Irvine, KY

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Spencer Drug LLC275 N Court Street, Irvine, KY 40336-1077(606) 723-0044 Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Heat & Cold Applications|Canes and/or Crutches|Walkers|Orthoses: Off-The-Shelf Does not accept assignmentParticipating since Apr 12, 2011

National Provider Directory

National Provider Directory
Tax ID family
Estill Clinic Pharmacy5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719187200000",
    "number": "1316975923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "275 COURT ST",
            "city": "IRVINE",
            "state": "KY",
            "postal_code": "403361077",
            "telephone_number": "606-723-0044",
            "fax_number": "606-723-0054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 COURT ST",
            "city": "IRVINE",
            "state": "KY",
            "postal_code": "403361077",
            "telephone_number": "606-723-0044",
            "fax_number": "606-723-0054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPENCER DRUG LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-30",
        "last_updated": "2024-06-24",
        "certification_date": "2024-06-24",
        "status": "A",
        "authorized_official_last_name": "SPENCER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "OWNER AND PIC",
        "authorized_official_telephone_number": "606-723-5446",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "KY",
            "license": "P07407",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "71001235310",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2126015",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Estill Clinic Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Irvine, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.