1942513551 NPI number — ELEMENTS TO WELLNESS, LLC

Table of content: DR. EMILY MARI SPARKS PHARMD (NPI 1558133595)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942513551 NPI number — ELEMENTS TO WELLNESS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELEMENTS TO WELLNESS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942513551
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6 HEARTHSTONE CT
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
READING
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19606-3065
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-685-1761
Provider Business Mailing Address Fax Number:
610-779-3392

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 HEARTHSTONE CT
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
READING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19606-3065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-685-1761
Provider Business Practice Location Address Fax Number:
610-779-3392
Provider Enumeration Date:
07/24/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
MORGAN
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
610-685-1761

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  MSG000214 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 133VN1006X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)