SPARTAN PHARMACY INC
NPI: 1124116298
· BETHEL PARK, PA 15102
· Community/Retail Pharmacy
· NPI assigned 10/11/2006
$264.00
Total Medicaid Paid
Provider Details
| Authorized Official | RICE, ADAM (OWNER) |
| Parent Organization | SPARTAN PHARMACY INC |
| NPI Enumeration Date | 10/11/2006 |
Related Entities
Other providers sharing the same authorized official: RICE, ADAM
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2022 |
24 |
$264.00 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90756 |
|
12 |
12 |
$132.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
12 |
12 |
$132.00 |