MEDICARE: MR. LANCE SPARKS RPH

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	37591	TX

General Provider Information

NPI Number	:	1679800023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LANCE SPARKS RPH

Provider Business Mailing Address
First Line	:	204 BEDFORD RD
Second Line	:	APT 318
City	:	BEDFORD
State	:	TX
Zip	:	76022-6290
Country	:	US
Telephone Number	:	817-285-8335
Fax Number	:

Provider Business Practice Location Address
First Line	:	6984 RUFE SNOW DR
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180
Country	:	US
Telephone Number	:	817-427-9353
Fax Number	:

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

Provider Enumeration Date	:	11/05/2009
Last Update Date	:	11/05/2009

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Directions to “ MR. LANCE SPARKS RPH” Practice Location

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