Basic Information
| Provider Information | |||||||||
| NPI: | 1508352360 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SPIVEY | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | SCOTT | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | BS RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2511 OXMOOR BLVD SW | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358033433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3194717772 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4226 OAKWOOD AVE NW | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358104066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2563612087 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2018 | ||||||||
| LastUpdateDate: | 07/05/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 18603 | AL | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.