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NPI Code Detail

MEDICARE: TERA SPARKS

MEDICARE: TERA SPARKS
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
1183500000XPharmacist014582KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1014582OTHERKYSTATE LICENSE NUMBER

General Provider Information

NPI Number : 1366889867
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERA SPARKS
Provider Business Mailing Address
First Line : 1019 CUMBERLAND FALLS HWY
Second Line :
City : CORBIN
State : KY
Zip : 40701-2735
Country : US
Telephone Number : 606-526-0755
Fax Number :
Provider Business Practice Location Address
First Line : 1019 CUMBERLAND FALLS HWY
Second Line :
City : CORBIN
State : KY
Zip : 40701-2735
Country : US
Telephone Number : 606-526-0755
Fax Number : 606-526-9589
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2013
Last Update Date : 05/24/2013

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Directions to “ TERA SPARKS ” Practice Location

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