Provider Demographics
NPI:1548710262
Name:SPARKMAN, CORTNEY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CORTNEY
Middle Name:
Last Name:SPARKMAN
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 1:7705 N JEFFERSON PLACE CIR
Mailing Address - Street 2:APT. O
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-8626
Mailing Address - Country:US
Mailing Address - Phone:312-965-0564
Mailing Address - Fax:
Practice Address - Street 1:220 N ALEXANDER AVE
Practice Address - Street 2:
Practice Address - City:PORT ALLEN
Practice Address - State:LA
Practice Address - Zip Code:70767-2514
Practice Address - Country:US
Practice Address - Phone:312-965-0564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.021773183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist