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Organization
SPARTA PHARMACY LLC.
Active
Organization
SPARTA PHARMACY LLC.
Active
Other names
SPARTA PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
TOM BRIESKE (MANAGER)
(608) 386-9039
Entity
Organization
Contact information
Practice address
201 S WATER ST, SPARTA, WI 54656-1724
(608) 269-2949
(608) 269-3330
Mailing address
PO BOX 185, WEST SALEM, WI 54669-0185
(608) 269-2949
(608) 269-3330
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
8783042
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2111020
PK
—
05
—
33296600
—
WI
Enumeration date
02/27/2007
Last updated
12/02/2014
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