MEDICARE: RONISHA CLARK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	5302418262	MI

General Provider Information

NPI Number	:	1023951696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONISHA CLARK

Provider Business Mailing Address
First Line	:	2240 CEDAR ST
Second Line	:
City	:	HOLT
State	:	MI
Zip	:	48842-1201
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2240 CEDAR ST
Second Line	:
City	:	HOLT
State	:	MI
Zip	:	48842-1201
Country	:	US
Telephone Number	:	517-694-1994
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2026
Last Update Date	:	04/10/2026

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Directions to “ RONISHA CLARK ” Practice Location

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