# SPARTA PHARMACY LLC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** SPARTA PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528194933
- **Authorized official:** TOM BRIESKE (MANAGER)
- **Authorized official phone:** (608) 386-9039

## Contact information

- **Practice address:** 201 S WATER ST, SPARTA, WI 54656-1724
- **Practice address phone:** (608) 269-2949
- **Practice address fax:** (608) 269-3330
- **Mailing address:** PO BOX 185, WEST SALEM, WI 54669-0185
- **Mailing address phone:** (608) 269-2949
- **Mailing address fax:** (608) 269-3330

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 8783042 | WI | Yes |

## Other

- **Enumeration date:** 02/27/2007
- **Last updated:** 12/02/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2111020 | PK | — |
| 05 | — | 33296600 | — | WI |