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NPI Code Detail

MEDICARE: DR. KELLY LYNN CLARK PHARM D

MEDICARE: DR. KELLY LYNN CLARK PHARM D
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
1183500000XPharmacist19526CO

General Provider Information

NPI Number : 1659752806
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KELLY LYNN CLARK PHARM D
Provider Business Mailing Address
First Line : 7805 E 35TH AVE
Second Line :
City : DENVER
State : CO
Zip : 80238-2458
Country : US
Telephone Number : 720-941-7146
Fax Number : 720-941-8046
Provider Business Practice Location Address
First Line : 7805 E 35TH AVE
Second Line :
City : DENVER
State : CO
Zip : 80238-2458
Country : US
Telephone Number : 720-941-7146
Fax Number : 720-941-8046
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2015
Last Update Date : 10/15/2019

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Directions to “ DR. KELLY LYNN CLARK PHARM D” Practice Location

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