Provider Demographics
NPI:1376148197
Name:SPARROW, WAYNE D
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:D
Last Name:SPARROW
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 1:4894 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EMINENCE
Mailing Address - State:KY
Mailing Address - Zip Code:40019-1018
Mailing Address - Country:US
Mailing Address - Phone:502-845-5027
Mailing Address - Fax:502-845-5077
Practice Address - Street 1:4894 N MAIN ST
Practice Address - Street 2:
Practice Address - City:EMINENCE
Practice Address - State:KY
Practice Address - Zip Code:40019-1018
Practice Address - Country:US
Practice Address - Phone:502-845-5027
Practice Address - Fax:502-845-5077
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY008128183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist