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General NPI Number Information
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NPI Number | 1477067247
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Entity Type | Individual
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Provider Name | BRIAN CLARK ASTON PHARM D
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Gender | Male
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Dates
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Enumeration Date | 11/30/2017
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Last Update Date | 11/30/2017
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Provider Practice Location Address
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Address Line | 7270 MONTGOMERY RD
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City | ELKRIDGE
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State | MD
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Zip | 21075-5268
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Country | US
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Telephone | 410-796-3344
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Fax |
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Provider Business Mailing Address
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Address Line | 818 THE OLD STATION CT
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City | WOODBINE
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State | MD
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Zip | 21797-8760
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Country | US
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Telephone | 443-280-1217
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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 | 25104
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License Number State | MD
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