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General NPI Number Information
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NPI Number | 1659335370
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Entity Type | Individual
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Provider Name | THOMAS WASHINGTON CLARK RPH
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Gender | Male
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Dates
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Enumeration Date | 04/12/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 425 W 7TH ST
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City | COLUMBIA
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State | TN
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Zip | 38401-3134
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Country | US
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Telephone | 931-388-3232
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Fax | 931-380-2075
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Provider Business Mailing Address
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Address Line | 1441 REESE RD
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City | LEWISBURG
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State | TN
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Zip | 37091-5238
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Country | US
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Telephone | 931-359-3976
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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 | C3577
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License Number State | TN
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