Healthcare Provider Details

I. General information

NPI: 1851222426
Provider Name (Legal Business Name): MICHAEL ERIC CLARK PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 E HIGHLAND AVE
SAN BERNARDINO CA
92404-3603
US

IV. Provider business mailing address

103 E HIGHLAND AVE
SAN BERNARDINO CA
92404-3603
US

V. Phone/Fax

Practice location:
  • Phone: 909-882-3353
  • Fax: 909-882-7849
Mailing address:
  • Phone: 909-882-3353
  • Fax: 909-882-7849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number52803
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: