Healthcare Provider Details

I. General information

NPI: 1982208161
Provider Name (Legal Business Name): ASHLEY MARIE CLARK PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2020
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5051 SE 110TH ST
BELLEVIEW FL
34420-3115
US

IV. Provider business mailing address

5850 NE 20TH AVE
FORT LAUDERDALE FL
33308-2427
US

V. Phone/Fax

Practice location:
  • Phone: 352-480-5797
  • Fax:
Mailing address:
  • Phone: 954-673-4823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS61261
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: