Healthcare Provider Details

I. General information

NPI: 1184648032
Provider Name (Legal Business Name): LINDA MARIE EUGENIO CLARK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 PAGE ST
NEW BEDFORD MA
02740-3464
US

IV. Provider business mailing address

15 ANTHONY ST
NEW BEDFORD MA
02740-3402
US

V. Phone/Fax

Practice location:
  • Phone: 508-997-1515
  • Fax:
Mailing address:
  • Phone: 508-991-4135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number21469
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number21469
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number21469
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: