Provider Demographics
NPI:1790592806
Name:SPARKS, JEREMY RYAN (PHARMD)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:RYAN
Last Name:SPARKS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5339 CITRUS BLVD APT L369
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70123-7934
Mailing Address - Country:US
Mailing Address - Phone:727-251-0188
Mailing Address - Fax:
Practice Address - Street 1:1 DREXEL DRIVE
Practice Address - Street 2:BOX COP-DCAS
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70125-1098
Practice Address - Country:US
Practice Address - Phone:727-251-0188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS579731835P2201X
LAPST.0235801835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care