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General NPI Number Information
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NPI Number | 1376324285
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Entity Type | Individual
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Provider Name | ROBERT JOSEPH CLARK II
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Gender | Male
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Dates
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Enumeration Date | 10/09/2023
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 232 G ST
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City | SALIDA
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State | CO
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Zip | 81201-2019
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Country | US
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Telephone | 719-539-6933
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Fax |
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Provider Business Mailing Address
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Address Line | 15 HEATHERWOOD RD
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City | FAIRPORT
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State | NY
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Zip | 14450-1131
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Country | US
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Telephone | 585-410-4268
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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 | 070839
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License Number State | NY
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