Provider Demographics
NPI:1417765033
Name:SPARKS, MONICA JACQUELYN (PHARMD)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:JACQUELYN
Last Name:SPARKS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08091-9249
Mailing Address - Country:US
Mailing Address - Phone:856-562-6345
Mailing Address - Fax:
Practice Address - Street 1:309 GROVE AVE
Practice Address - Street 2:
Practice Address - City:WEST BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08091-9249
Practice Address - Country:US
Practice Address - Phone:856-562-6345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-28
Last Update Date:2024-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04403800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist