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General NPI Number Information
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NPI Number | 1205280807
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Entity Type | Organization
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Legal Business Name | SPARTA APOTHECARY INC
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Dates
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Enumeration Date | 04/20/2016
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Last Update Date | 05/14/2019
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Provider Practice Location Address
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Address Line | 285 W TURN TABLE RD STE B
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City | SPARTA
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State | TN
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Zip | 38583-1366
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Country | US
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Telephone | 931-836-3187
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Fax | 931-836-3398
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Provider Business Mailing Address
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Address Line | 285 W TURN TABLE RD STE B
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City | SPARTA
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State | TN
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Zip | 38583-1366
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Country | US
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Telephone | 931-836-3187
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Fax | 931-836-3398
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Authorized Official
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Title or Position | PRESIDENT
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Name | JENNIFER TATUM-CRANFORD
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Credential | PHARM D
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Telephone | 931-836-3187
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 2929
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License Number State | TN
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