Provider Demographics
NPI:1275660748
Name:SPARKS, MISTY ANN (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:ANN
Last Name:SPARKS
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 1:45 SPARKS LN
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:AR
Mailing Address - Zip Code:72550-9536
Mailing Address - Country:US
Mailing Address - Phone:870-251-2118
Mailing Address - Fax:870-269-5120
Practice Address - Street 1:301 WEST MAIN
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:AR
Practice Address - Zip Code:72560
Practice Address - Country:US
Practice Address - Phone:870-269-3253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR8886183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist