Provider Demographics
NPI:1821400797
Name:SPARTA PHARMACY
Entity Type:Organization
Organization Name:SPARTA PHARMACY
Other - Org Name:SPARTA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:SHARAD
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:973-512-3131
Mailing Address - Street 1:61 SPARTA AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-1822
Mailing Address - Country:US
Mailing Address - Phone:973-512-3131
Mailing Address - Fax:973-512-3336
Practice Address - Street 1:61 SPARTA AVE UNIT B
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-1822
Practice Address - Country:US
Practice Address - Phone:973-512-3131
Practice Address - Fax:973-512-3336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-27
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7294570001Medicare NSC