Provider Demographics
NPI:1578649281
Name:SPARTA PHARMACY SERVICES
Entity Type:Organization
Organization Name:SPARTA PHARMACY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DESMOND
Authorized Official - Middle Name:M
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:973-729-5000
Mailing Address - Street 1:1 THEATRE CTR
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-2405
Mailing Address - Country:US
Mailing Address - Phone:973-729-5000
Mailing Address - Fax:973-729-9252
Practice Address - Street 1:1 THEATRE CTR
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-2405
Practice Address - Country:US
Practice Address - Phone:973-729-5000
Practice Address - Fax:973-729-9252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4294700OtherPHARMACY #