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JUSTIN CLARK PHARM.D.
>> Pharmacist >> Pharmacy Service ProvidersRegistrant NPI Number: 1942531868
Individual Registrant: JUSTIN CLARK PHARM.D.
Gender: M
Sole Proprietor
Gender: M
Sole Proprietor
Location and contact information for practice:
12050 N DOVE MT BLVD MARANA, AZ 85658 US
Tel: 520-225-0770 Fax: 520-225-0776
Tel: 520-225-0770 Fax: 520-225-0776
Contact information for business:
1301 W LAMBERT LN APT 9203 ORO VALLEY, AZ 85737-7114 US
Tel: -- Fax: --
Tel: -- Fax: --
Registration Information:
NPI: 1942531868
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 183500000X | Pharmacy Service Providers Pharmacist | AZ | S016609 |
| N | 183500000X | Pharmacy Service Providers Pharmacist | NM | RP00007152 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
