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General NPI Number Information
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NPI Number | 1790070332
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Entity Type | Individual
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Provider Name | DAIN PETERSON CLARK PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 06/11/2011
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Last Update Date | 06/11/2011
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Provider Practice Location Address
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Address Line | 1950 E COUNTY LINE RD
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City | HIGHLANDS RANCH
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State | CO
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Zip | 80126-2437
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Country | US
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Telephone | 303-797-0771
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Fax |
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Provider Business Mailing Address
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Address Line | 1950 E COUNTY LINE RD
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City | HIGHLANDS RANCH
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State | CO
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Zip | 80126-2437
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Country | US
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Telephone | 303-797-0771
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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 | 18875
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License Number State | CO
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