Healthcare Provider Details

I. General information

NPI: 1720342496
Provider Name (Legal Business Name): RALPH L CLARKE PHARM D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 06/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 E MEDICAL CENTER DR
ST GEORGE UT
84790-2123
US

IV. Provider business mailing address

1380 E MEDICAL CENTER DR
ST GEORGE UT
84790-2123
US

V. Phone/Fax

Practice location:
  • Phone: 435-251-2400
  • Fax: 435-251-2413
Mailing address:
  • Phone: 435-251-2400
  • Fax: 435-251-2413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number131668-1701
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: