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General NPI Number Information
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NPI Number | 1255800140
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Entity Type | Individual
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Provider Name | JERICA A CLARK PHARMD
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Gender | Female
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Dates
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Enumeration Date | 11/20/2018
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Last Update Date | 11/20/2018
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Provider Practice Location Address
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Address Line | 3621 N HIGHWAY 231
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City | PANAMA CITY
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State | FL
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Zip | 32404-9743
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Country | US
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Telephone | 850-914-0200
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Fax |
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Provider Business Mailing Address
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Address Line | 1315 BALBOA AVE UNIT 203
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City | PANAMA CITY
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State | FL
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Zip | 32401-7200
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Country | US
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Telephone | 850-532-3405
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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 | PS58206
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License Number State | FL
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