Provider Demographics
NPI:1821192881
Name:SPARTA APOTHECARY INC
Entity Type:Organization
Organization Name:SPARTA APOTHECARY INC
Other - Org Name:PAYLESS FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:TATUM-CRANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:931-836-3187
Mailing Address - Street 1:285 W TURN TABLE RD
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:TN
Mailing Address - Zip Code:38583-1366
Mailing Address - Country:US
Mailing Address - Phone:931-836-3187
Mailing Address - Fax:931-836-3398
Practice Address - Street 1:285 W TURN TABLE RD
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:TN
Practice Address - Zip Code:38583-1366
Practice Address - Country:US
Practice Address - Phone:931-836-3187
Practice Address - Fax:931-837-9339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
TN00000029293336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN9449894Medicaid
2091619OtherPK
TN9449894Medicaid