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General NPI Number Information
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NPI Number | 1205436227
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Entity Type | Individual
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Provider Name | ANGEL A CLARK DPH
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Gender | Female
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Dates
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Enumeration Date | 10/28/2020
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Last Update Date | 10/28/2020
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Provider Practice Location Address
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Address Line | 207 S MEMORIAL DR
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City | TULSA
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State | OK
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Zip | 74112-2201
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Country | US
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Telephone | 918-838-2937
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Fax |
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Provider Business Mailing Address
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Address Line | 11640 E 24TH ST
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City | TULSA
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State | OK
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Zip | 74129-5621
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Country | US
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Telephone | 918-289-9142
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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 | 13578
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License Number State | OK
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