Active NPI
Elizabeth Sparks
- Pharmacist
- Charleston, SC
National Provider Identifier
1730362195
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 35649
- Practice address
- 200 Rutledge Ave
Charleston, SC 29403-5848 - Phone
- (843) 779-3690
- NPI assigned
- Dec 8, 2007
- Last updated
- Aug 13, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051170 | NY | |
| Pharmacist | 183500000X | 28RI02954100 | NJ | |
| Pharmacist | 183500000X | 35649 | SC | Primary |
Addresses
Primary practice location
200 Rutledge Ave
Charleston, SC 29403-5848
Mailing address
200 Rutledge Ave
Charleston, SC 29403-5848
Phone (843) 779-3690
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28RI02954100 | NJ | MD | Pharmacist |
| 051170 | NY | MD | Pharmacist |
| 35649 | SC | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eckerd Corporation | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1197072000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597276800000",
"number": "1730362195",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 RUTLEDGE AVE",
"city": "CHARLESTON",
"state": "SC",
"postal_code": "294035848",
"telephone_number": "843-779-3690",
"fax_number": "843-779-3691"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 RUTLEDGE AVE",
"city": "CHARLESTON",
"state": "SC",
"postal_code": "294035848",
"telephone_number": "843-779-3690"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPARKS",
"first_name": "ELIZABETH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-12-08",
"last_updated": "2020-08-13",
"certification_date": "2020-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "051170",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NJ",
"license": "28RI02954100",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "SC",
"license": "35649",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charleston, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.