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1447880760 NPI number — TRACY C SPARKMAM PHARM D

NPI Number: 1447880760
Health Care Provider/Practitioner: TRACY C SPARKMAM PHARM D

Information about “1447880760” NPI (TRACY C SPARKMAM PHARM D) exists in 1447880760 in HTML format HTML  |  1447880760 in plain Text format TXT  |  1447880760 in PDF (Portable Document Format) PDF  |  1447880760 in an XML format XML  formats.

NPI Number : 1447880760 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1447880760",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SPARKMAM",
    "FirstName": "TRACY",
    "MiddleName": "C",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "PHARM D",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "SHEWELL",
    "OtherFirstName": "TRACY",
    "OtherMiddleName": null,
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "PHARM D",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "3930 44TH AVENUE DR STOP 1",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MOLINE",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "61265-3893",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "309-736-2275",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3930 44TH AVENUE DR STOP 1",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MOLINE",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "61265-3893",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "309-736-2275",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/26/2020",
    "LastUpdateDate": "09/24/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "183500000X",
        "TaxonomyName": "Pharmacist",
        "LicenseNumber": "051298104",
        "LicenseNumberStateCode": "IL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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