Provider Demographics
NPI:1033327481
Name:SPARKS, LLOYD WADE (RPH)
Entity Type:Individual
Prefix:MR
First Name:LLOYD
Middle Name:WADE
Last Name:SPARKS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1161 COUNTY ROAD 15140
Mailing Address - Street 2:
Mailing Address - City:BLOSSOM
Mailing Address - State:TX
Mailing Address - Zip Code:75416-5703
Mailing Address - Country:US
Mailing Address - Phone:903-652-2200
Mailing Address - Fax:
Practice Address - Street 1:662 BONHAM ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-4118
Practice Address - Country:US
Practice Address - Phone:903-784-2536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38406183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist