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General NPI Number Information
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NPI Number | 1063639995
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Entity Type | Individual
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Provider Name | JOHN C CLARK PHARM D
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Gender | Male
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5 REGENT ST SUITE 506
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City | LIVINGSTON
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State | NJ
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Zip | 07039-1675
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Country | US
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Telephone | 800-552-3461
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Fax |
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Provider Business Mailing Address
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Address Line | 173 HIGH ST
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City | NUTLEY
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State | NJ
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Zip | 07110-1176
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Country | US
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Telephone | 973-667-4904
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 28RI03106100
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License Number State | NJ
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