Organization
SPARKS PHARMACY INC
Active
Other names
Bolivar Drug
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN SUMMERS (PRESIDENT)
(417) 326-7455
Entity
Organization
Contact information
Practice address
1001 E CAMBRIDGE ST, BOLIVAR, MO 65613-3502
(417) 326-7455
(417) 326-7757
Mailing address
1001 E CAMBRIDGE ST, BOLIVAR, MO 65613-3502
(417) 326-7455
(417) 326-7757
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
005482
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2051548
PK
—
05
—
602599607
—
MO
05
—
622599603
—
MO
Enumeration date
08/14/2006
Last updated
01/21/2016
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