Provider Demographics
NPI:1033455829
Name:SPARKS, TOM L
Entity Type:Individual
Prefix:DR
First Name:TOM
Middle Name:L
Last Name:SPARKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 E HIGHWAY 7 RD
Mailing Address - Street 2:
Mailing Address - City:MARLOW
Mailing Address - State:OK
Mailing Address - Zip Code:73055-8641
Mailing Address - Country:US
Mailing Address - Phone:580-540-6565
Mailing Address - Fax:
Practice Address - Street 1:1206 N HIGHWAY 81
Practice Address - Street 2:STE 42
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-1790
Practice Address - Country:US
Practice Address - Phone:580-251-0107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-24
Last Update Date:2012-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7971183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist