Provider Demographics
NPI:1912135948
Name:SPARROW, NICHOLAS DALE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:DALE
Last Name:SPARROW
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 1:101 S MOORE AVE
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-5091
Mailing Address - Country:US
Mailing Address - Phone:918-342-6623
Mailing Address - Fax:
Practice Address - Street 1:943 HUALAPAI WAY
Practice Address - Street 2:
Practice Address - City:PEACH SPRINGS
Practice Address - State:AZ
Practice Address - Zip Code:86434
Practice Address - Country:US
Practice Address - Phone:928-769-2992
Practice Address - Fax:928-769-1336
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-29
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6085618-8911183500000X
UT6085618-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist