Provider Demographics
NPI:1003100298
Name:SPARK, EDWARD (PHARMD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:SPARK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5010 FOUNDERS PKWY
Mailing Address - Street 2:T-1326
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-7838
Mailing Address - Country:US
Mailing Address - Phone:303-663-4715
Mailing Address - Fax:303-663-4715
Practice Address - Street 1:5010 FOUNDERS PKWY
Practice Address - Street 2:T-1326
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108-7838
Practice Address - Country:US
Practice Address - Phone:303-663-4715
Practice Address - Fax:303-663-4715
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-05
Last Update Date:2011-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17544183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist