Provider Demographics
NPI:1174701015
Name:SPARKS, DOROTHY MARIE (RPH)
Entity type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:MARIE
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 1:747 LONG LAKE DR
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-8559
Mailing Address - Country:US
Mailing Address - Phone:407-625-8078
Mailing Address - Fax:407-971-6763
Practice Address - Street 1:747 LONG LAKE DR
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-8559
Practice Address - Country:US
Practice Address - Phone:407-625-8078
Practice Address - Fax:407-971-6763
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-02
Last Update Date:2008-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS16543183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist