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NPI Code Detail

MEDICARE: BESPOKE PHARMACEUTICAL

MEDICARE: BESPOKE PHARMACEUTICAL
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
13336C0004XCompounding Pharmacy

General Provider Information

NPI Number : 1861287351
Entity Type Code : Organization
Provider Name (Legal Business Name) : BESPOKE PHARMACEUTICAL
Provider Business Mailing Address
First Line : 5795 N HOLLYWOOD BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89115-1833
Country : US
Telephone Number : 725-529-3523
Fax Number :
Provider Business Practice Location Address
First Line : 5795 N HOLLYWOOD BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89115-1833
Country : US
Telephone Number : 725-529-3523
Fax Number :
Authorized Official
Title or Position : CHIEF PHARMACIST
Name : ERIC SPARKS
Credential : PHARMD
Telephone Number : 702-427-0707
Provider Enumeration Date : 04/14/2025
Last Update Date : 04/15/2025

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Directions to “BESPOKE PHARMACEUTICAL ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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