Individual
MR. LARRY W SPARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMACIST
Contact information
Practice address
1115 N RIVERSIDE DR, ESPANOLA, NM 87532-2802
(505) 753-7005
Mailing address
1115 N RIVERSIDE DR, ESPANOLA, NM 87532-2802
(505) 875-3700
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
3195
NM
Other
Enumeration date
09/30/2010
Last updated
09/30/2010
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