Healthcare Provider Details

I. General information

NPI: 1376464073
Provider Name (Legal Business Name): THOMAS CLARK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8350 CASCADE AVE UNIT 3207
WEST DES MOINES IA
50266-8587
US

IV. Provider business mailing address

8350 CASCADE AVE UNIT 3207
WEST DES MOINES IA
50266-8587
US

V. Phone/Fax

Practice location:
  • Phone: 612-968-4856
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number25583
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: