Provider Demographics
NPI:1144461302
Name:SPAINHOUR, RANDOLPH FLETCHER (RPH)
Entity type:Individual
Prefix:
First Name:RANDOLPH
Middle Name:FLETCHER
Last Name:SPAINHOUR
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WALLACE
Mailing Address - State:NC
Mailing Address - Zip Code:28466-2720
Mailing Address - Country:US
Mailing Address - Phone:910-285-2937
Mailing Address - Fax:910-285-8550
Practice Address - Street 1:111 S. WRIGHT ST.
Practice Address - Street 2:
Practice Address - City:BURGAW
Practice Address - State:NC
Practice Address - Zip Code:28425-0427
Practice Address - Country:US
Practice Address - Phone:910-259-7080
Practice Address - Fax:910-259-7788
Is Sole Proprietor?:No
Enumeration Date:2009-03-18
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC06300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist