Healthcare Provider Details

I. General information

NPI: 1568741783
Provider Name (Legal Business Name): IVY CLARK PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2011
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 BROOKLAWN ST
FARRAGUT TN
37934-2875
US

IV. Provider business mailing address

220 WEARS VALLEY RD
PIGEON FORGE TN
37863-4215
US

V. Phone/Fax

Practice location:
  • Phone: 865-428-0629
  • Fax: 865-908-5068
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number35895
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: