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General NPI Number Information
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NPI Number | 1346639465
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Entity Type | Individual
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Provider Name | DORYN ROCHE CLARK PHARM.D
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Gender | Female
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Dates
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Enumeration Date | 01/13/2015
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Last Update Date | 08/26/2019
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Provider Practice Location Address
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Address Line | 2103 VETERANS BLVD UNIT 2
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City | DUBLIN
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State | GA
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Zip | 31021-7502
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Country | US
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Telephone | 478-274-5534
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9000
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City | DUBLIN
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State | GA
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Zip | 31040-9000
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Country | US
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Telephone | 478-274-5534
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Fax | 866-817-1445
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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 | RPH028266
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License Number State | GA
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