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General NPI Number Information
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NPI Number | 1255628590
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Entity Type | Individual
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Provider Name | ASHLEY LOUISE CLARK PHARMD
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Gender | Female
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Dates
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Enumeration Date | 07/07/2011
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Last Update Date | 05/06/2013
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Provider Practice Location Address
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Address Line | 551 NATIONAL HEALTHCARE DRIVE DAYTONA BEACH VA OUTPATIENT CLINIC
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City | DAYTONA BEAC
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State | FL
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Zip | 32608-1135
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Country | US
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Telephone | 352-379-6062
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Fax |
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Provider Business Mailing Address
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Address Line | 140 ACKLINS CIR APT 110
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City | DAYTONA BEACH
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State | FL
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Zip | 32119-9771
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Country | US
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Telephone | 386-323-7500
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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 | 1835P1300X
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Taxonomy Name | Psychiatric Pharmacist
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License Number | PS46401
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License Number State | FL
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