Sparks Pharmacy Inc

Primary specialty

Compounding PharmacyTaxonomy code 3336C0004X

License

005482 Issued in MO

Legal business name

SPARKS PHARMACY INC

Practice address

2000 S Springfield Ave
Bolivar, MO 65613-9654

Phone

(417) 777-7455

Fax

(417) 777-7455

NPI assigned

Aug 17, 2006

Organization subpart

No

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

Authorized official

Name

Jeffrey Sparks

Title

President

Phone

(417) 777-7455

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Bolivar Drug Compounding and Wellness Doing business as

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

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1382745600000",
    "number": "1013021328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 33",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656130033",
            "telephone_number": "417-777-7455",
            "fax_number": "417-777-7455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 S SPRINGFIELD AVE",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656139654",
            "telephone_number": "417-777-7455",
            "fax_number": "417-777-7455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPARKS PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-17",
        "last_updated": "2013-10-26",
        "status": "A",
        "authorized_official_last_name": "SPARKS",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "417-777-7455"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "MO",
            "license": "005482",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2137787",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bolivar Drug Compounding and Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lynetta S Smith, MS, RDN, LD
• Thomas James Sneed, DPT
• Southern Light Community Counseling
• Southern Light Residential
• Southwest Ozark Optometric Physicians Inc
• Sparks Pharmacy Inc
• Jeff Sparks
• John Richard Spooner, PSY.D.
• Cassie Stephans, PT
• Stephens Pharmacy Inc

• Compounding Pharmacy in Bolivar, MO
• Providers in Bolivar, MO by specialty
• Compounding Pharmacy in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.