MEDICARE: MICHAEL SPARKMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS58576	FL

General Provider Information

NPI Number	:	1083218119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL SPARKMAN

Provider Business Mailing Address
First Line	:	30 SARASOTA ST
Second Line	:
City	:	DESTIN
State	:	FL
Zip	:	32550-4688
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	60 S HOLIDAY RD
Second Line	:
City	:	MIRAMAR BEACH
State	:	FL
Zip	:	32550-3996
Country	:	US
Telephone Number	:	850-269-7780
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2020
Last Update Date	:	11/30/2020

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