Provider Demographics
NPI:1871196303
Name:SPARDA, STEPHANIE VASILE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:VASILE
Last Name:SPARDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 HANNAFORD DR
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9057
Mailing Address - Country:US
Mailing Address - Phone:207-883-7674
Mailing Address - Fax:207-883-7685
Practice Address - Street 1:31 HANNAFORD DR
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-9057
Practice Address - Country:US
Practice Address - Phone:207-883-7674
Practice Address - Fax:207-883-7685
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR4310183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist