Spencers Drug Store Inc
Organization Active NPI Community/Retail Pharmacy · Blackstone, VA
NPI 1780744490 · NPPES record last updated Nov 29, 2016
Key facts
- NPI
- 1780744490
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 0201000758 (VA)
- Legal business name
- SPENCERS DRUG STORE INC
- Practice address
- 100 N Main St
Blackstone, VA 23824-1424 - Phone
- (434) 292-3132
- Fax
- (434) 292-6467
- NPI assigned
- Dec 11, 2006
- Organization subpart
- No
Authorized official
- Name
- Keri Yancey
- Title
- Owner
- Phone
- (434) 292-3132
Corporate family (same tax ID) 1
Practitioners 1
-
Keri Hoye Yancey, PHARM D
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120510000037 | VA | Part B Supplier - Mass Immunization (Roster Biller Only) | 5395907216 | Practice locations: Blackstone, VA |
National Provider Directory
- Tax ID family
- Spencers Drug Store Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 0201000758 | VA | Yes |
| Long Term Care Pharmacy | 3336L0003X |
Addresses
Primary practice location
100 N Main St
Blackstone, VA 23824-1424
Mailing address
100 N Main St
Blackstone, VA 23824-1424
Phone (434) 292-3132
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2144016 | Other | PK |
Other names
- Spencers Drug Store Inc
Other providers in Blackstone, VA
- Michaela Nicole Cruz San Juan
- Rauan Satbekov
- Specialty Healthcare
- Steven N. Spence
- Spencer'S Drug Store, Inc.
- Kristina Diane Staples
- Starke Behavioral Health Association Inc
- Starke Behavioral Health Services LLC
- Tisha Stewart
- Dennis D Swan
All providers in Blackstone, VA · Community/Retail Pharmacy in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 29, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.