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NPI Code Detail

MEDICARE: MRS. LAURA LEE CLARK RPH

MEDICARE: MRS. LAURA LEE CLARK RPH
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
1183500000XPharmacistRP043187LPA

General Provider Information

NPI Number : 1215101084
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LAURA LEE CLARK RPH
Provider Business Mailing Address
First Line : 920 RED LION RD
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19115-1500
Country : US
Telephone Number : 215-676-6279
Fax Number : 215-969-0586
Provider Business Practice Location Address
First Line : 920 RED LION RD
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19115-1500
Country : US
Telephone Number : 215-676-6279
Fax Number : 215-969-0586
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2008
Last Update Date : 04/14/2008

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Directions to “ MRS. LAURA LEE CLARK RPH” Practice Location

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