Individual
TIA SPARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1500 S LAKE PARK AVE, HOBART, IN 46342-6638
(219) 947-6480
Mailing address
1500 S LAKE PARK AVE, HOBART, IN 46342-6638
(219) 947-6480
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
26021263A
IN
Other
Enumeration date
05/01/2018
Last updated
05/01/2018
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