Healthcare Provider Details

I. General information

NPI: 1487991345
Provider Name (Legal Business Name): WILLISA P CLARKE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2013
Last Update Date: 09/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 N FEDERAL HWY
LIGHTHOUSE POINT FL
33064-6610
US

IV. Provider business mailing address

3700 N FEDERAL HWY
LIGHTHOUSE POINT FL
33064-6610
US

V. Phone/Fax

Practice location:
  • Phone: 954-788-3094
  • Fax: 954-788-3097
Mailing address:
  • Phone: 954-788-3094
  • Fax: 954-788-3097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS49842
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: