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General NPI Number Information
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NPI Number | 1629679998
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Entity Type | Individual
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Provider Name | JAMES CLARK PHARMD
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Gender | Male
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Dates
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Enumeration Date | 11/03/2020
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Last Update Date | 11/03/2020
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Provider Practice Location Address
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Address Line | 5219 HIGHWAY 51 N
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City | SENATOBIA
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State | MS
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Zip | 38668-1719
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Country | US
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Telephone | 662-562-8266
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Fax | 662-562-8277
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Provider Business Mailing Address
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Address Line | 82 JILL RD
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City | SENATOBIA
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State | MS
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Zip | 38668-6881
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Country | US
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Telephone |
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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 | E-010415
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License Number State | MS
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