Provider Demographics
NPI:1396064242
Name:SPARKS, CAROLE LEIGH (RPH)
Entity type:Individual
Prefix:MRS
First Name:CAROLE
Middle Name:LEIGH
Last Name:SPARKS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 BEAVER CREEK PT.
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CO
Mailing Address - Zip Code:81620
Mailing Address - Country:US
Mailing Address - Phone:970-949-5437
Mailing Address - Fax:970-949-0576
Practice Address - Street 1:72 BEAVER CREEK PL.
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CO
Practice Address - Zip Code:81620
Practice Address - Country:US
Practice Address - Phone:970-949-5437
Practice Address - Fax:970-949-0576
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-18
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0002343183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist