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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
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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