Provider Demographics
NPI:1285077222
Name:SPARKMAN, MICHAEL (RPH)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:SPARKMAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-4247
Mailing Address - Country:US
Mailing Address - Phone:970-247-9435
Mailing Address - Fax:
Practice Address - Street 1:3130 MAIN AVE
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-4247
Practice Address - Country:US
Practice Address - Phone:970-247-9435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16956183500000X
KY009822183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist