MEDICARE: DR. ALYCIA 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	62657	CA

General Provider Information

NPI Number	:	1821525882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALYCIA CLARK

Provider Business Mailing Address
First Line	:	175 SANTA ELENA LN
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93108-2512
Country	:	US
Telephone Number	:	858-335-8990
Fax Number	:

Provider Business Practice Location Address
First Line	:	6100 WALLACE BECKNELL RD
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93117-3265
Country	:	US
Telephone Number	:	858-335-8990
Fax Number	:

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

Provider Enumeration Date	:	05/20/2017
Last Update Date	:	06/11/2021

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Directions to “ DR. ALYCIA CLARK ” Practice Location

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