Provider Demographics
NPI:1093218489
Name:BOX, SPARKLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SPARKLE
Middle Name:
Last Name:BOX
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 BLUEBIRD LN
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-3429
Mailing Address - Country:US
Mailing Address - Phone:219-794-4395
Mailing Address - Fax:
Practice Address - Street 1:1908 BLUEBIRD LN
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-3429
Practice Address - Country:US
Practice Address - Phone:219-794-4395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23021330A1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist