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General NPI Number Information
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NPI Number | 1346406782
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Entity Type | Individual
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Provider Name | STEPHANIE CLARK D. PH.
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Gender | Female
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Dates
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Enumeration Date | 08/05/2008
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Last Update Date | 08/05/2008
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Provider Practice Location Address
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Address Line | 931 S COLLEGIATE DR
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City | PARIS
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State | TX
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Zip | 75460-6307
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Country | US
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Telephone | 903-785-5656
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Fax | 903-785-5657
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Provider Business Mailing Address
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Address Line | 3920 47TH ST NE
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City | PARIS
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State | TX
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Zip | 75462-3173
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Country | US
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Telephone | 903-737-8404
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Fax | 903-785-5657
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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 | 45604
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License Number State | TX
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