Healthcare Provider Details

I. General information

NPI: 1972432714
Provider Name (Legal Business Name): LAURA CLARK RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 CHERRY ST
BLANCHESTER OH
45107-1346
US

IV. Provider business mailing address

1001 CHERRY ST
BLANCHESTER OH
45107-1346
US

V. Phone/Fax

Practice location:
  • Phone: 937-783-0270
  • Fax: 937-783-0295
Mailing address:
  • Phone: 937-783-0270
  • Fax: 937-783-0295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberC03236733
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: