Sparks Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

005482 Issued in MO

Legal business name

SPARKS PHARMACY INC

Doing business as

Bolivar Drug

Practice address

1001 E Cambridge St
Bolivar, MO 65613-3502

Phone

(417) 326-7455

Fax

(417) 326-7757

NPI assigned

Aug 14, 2006

Last updated

Jan 21, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ryan Summers

Title

President

Phone

(417) 326-7455

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• Bolivar Drug Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jeff Sparks

  • Pharmacist
  • Bolivar, MO
  • NPI 1932175965
  NPD (past)

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

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1453334400000",
    "number": "1801809785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 E CAMBRIDGE ST",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656133502",
            "telephone_number": "417-326-7455",
            "fax_number": "417-326-7757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 E CAMBRIDGE ST",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656133502",
            "telephone_number": "417-326-7455",
            "fax_number": "417-326-7757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPARKS PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-14",
        "last_updated": "2016-01-21",
        "status": "A",
        "authorized_official_last_name": "SUMMERS",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "417-326-7455"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MO",
            "license": "005482",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2051548",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "602599607",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "622599603",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bolivar Drug",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Thomas James Sneed, DPT
• Southern Light Community Counseling
• Southern Light Residential
• Southwest Ozark Optometric Physicians Inc
• Sparks Pharmacy Inc (Bolivar Drug Compounding and Wellness)
• Jeff Sparks
• John Richard Spooner, PSY.D.
• Cassie Stephans, PT
• Stephens Pharmacy Inc (Stephens Pharmacy)
• Stephens Pharmacy Inc (Stephens Healthcare Services)

• Community/Retail Pharmacy in Bolivar, MO
• Providers in Bolivar, MO by specialty
• Community/Retail Pharmacy in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2016; 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.