Healthcare Provider Details

I. General information

NPI: 1235839242
Provider Name (Legal Business Name): MEGAN ALISE CLARK PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN ALISE KOSCH PHARMD

II. Dates (important events)

Enumeration Date: 03/08/2023
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 SOUTHERN BLVD
KETTERING OH
45429-1221
US

IV. Provider business mailing address

4409 BRANDON LN
MIDDLETOWN OH
45042-4932
US

V. Phone/Fax

Practice location:
  • Phone: 937-298-3399
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number03440857
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: