Organization
SPARKS PHARMACY INC
Active
Other names
Bolivar Drug Compounding and Wellness
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY SPARKS (PRESIDENT)
(417) 777-7455
Entity
Organization
Contact information
Practice address
2000 S SPRINGFIELD AVE, BOLIVAR, MO 65613-9654
(417) 777-7455
(417) 777-7455
Mailing address
PO BOX 33, BOLIVAR, MO 65613-0033
(417) 777-7455
(417) 777-7455
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0004X
Compounding Pharmacy
Primary
005482
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2137787
PK
—
Enumeration date
08/17/2006
Last updated
10/26/2013
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