Provider Demographics
NPI:1942741905
Name:SPROUT, JOSEPH RAY (RPH)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:RAY
Last Name:SPROUT
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 1:122 EAST ACADEMY ST
Mailing Address - Street 2:PO BOX 339
Mailing Address - City:SHINGLEHOUSE
Mailing Address - State:PA
Mailing Address - Zip Code:16748-0339
Mailing Address - Country:US
Mailing Address - Phone:814-697-6331
Mailing Address - Fax:814-697-7437
Practice Address - Street 1:122 EAST ACADEMY ST
Practice Address - Street 2:
Practice Address - City:SHINGLEHOUSE
Practice Address - State:PA
Practice Address - Zip Code:16748-0339
Practice Address - Country:US
Practice Address - Phone:814-697-6331
Practice Address - Fax:814-697-7437
Is Sole Proprietor?:No
Enumeration Date:2017-03-10
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP034282L183500000X
NY037939183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist