Healthcare Provider Details

I. General information

NPI: 1952734923
Provider Name (Legal Business Name): CHELSEA N CLARK PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2013
Last Update Date: 08/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 ARMSTRONG RD 119A
BATTLE CREEK MI
49037-7314
US

IV. Provider business mailing address

1919 N PHILIP RD
NILES MI
49120-8617
US

V. Phone/Fax

Practice location:
  • Phone: 269-966-5600
  • Fax:
Mailing address:
  • Phone: 574-309-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number5302039377
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: