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General NPI Number Information
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NPI Number | 1245415116
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Entity Type | Individual
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Provider Name | WILLIAM J CLARK R.PH.
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Gender | Male
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Dates
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Enumeration Date | 01/09/2008
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Last Update Date | 02/25/2010
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Provider Practice Location Address
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Address Line | 5335 W GENESEE ST SUITE 20
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City | CAMILLUS
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State | NY
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Zip | 13031-2265
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Country | US
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Telephone | 315-487-0435
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Fax | 315-487-0332
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Provider Business Mailing Address
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Address Line | 104 FLEETWOOD LN
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City | MINOA
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State | NY
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Zip | 13116-1008
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Country | US
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Telephone | 315-656-2452
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Fax | 315-487-0332
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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 | 028201
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License Number State | NY
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