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General NPI Number Information
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NPI Number | 1780329672
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Entity Type | Individual
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Provider Name | SARAH ASHLEY CLARK RPT
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Gender | Female
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Dates
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Enumeration Date | 05/04/2022
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Last Update Date | 05/04/2022
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Provider Practice Location Address
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Address Line | 2865 ELMWOOD AVE
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City | KENMORE
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State | NY
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Zip | 14217-1328
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Country | US
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Telephone | 716-447-1757
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Fax | 716-447-9681
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Provider Business Mailing Address
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Address Line | 2270 CENTER CT N APT 2
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City | GRAND ISLAND
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State | NY
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Zip | 14072-1742
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Country | US
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Telephone | 716-343-1044
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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 | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 001706
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License Number State | NY
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