Individual
TERA SPARKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1019 CUMBERLAND FALLS HWY, CORBIN, KY 40701-2735
(606) 526-0755
(606) 526-9589
Mailing address
1019 CUMBERLAND FALLS HWY, CORBIN, KY 40701-2735
(606) 526-0755
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
014582
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
014582
STATE LICENSE NUMBER
KY
Enumeration date
05/24/2013
Last updated
05/24/2013
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