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NPI Code Detail

MEDICARE: MR. CLARENCE O WARDLEY PHARMD

MEDICARE: MR. CLARENCE O WARDLEY PHARMD
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
1183500000XPharmacistPS52286FL

General Provider Information

NPI Number : 1881088862
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CLARENCE O WARDLEY PHARMD
Provider Business Mailing Address
First Line : 5480 N UNIVERSITY DR
Second Line :
City : CORAL SPRINGS
State : FL
Zip : 33067-4603
Country : US
Telephone Number : 954-344-6437
Fax Number :
Provider Business Practice Location Address
First Line : 5480 N UNIVERSITY DR
Second Line :
City : CORAL SPRINGS
State : FL
Zip : 33067-4603
Country : US
Telephone Number : 954-344-6437
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2015
Last Update Date : 03/27/2015

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