Provider Demographics
NPI:1679800023
Name:SPARKS, LANCE (RPH)
Entity Type:Individual
Prefix:MR
First Name:LANCE
Middle Name:
Last Name:SPARKS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 BEDFORD RD
Mailing Address - Street 2:APT 318
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-6290
Mailing Address - Country:US
Mailing Address - Phone:817-285-8335
Mailing Address - Fax:
Practice Address - Street 1:6984 RUFE SNOW DR
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180
Practice Address - Country:US
Practice Address - Phone:817-427-9353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37591183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist