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General NPI Number Information
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NPI Number | 1841026408
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Entity Type | Individual
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Provider Name | CLARK JAY ASTRERA SANTIDAD PHARMD
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Gender | Male
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Dates
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Enumeration Date | 09/11/2024
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Last Update Date | 11/03/2025
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Provider Practice Location Address
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Address Line | 850 S RANCHO DR
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City | LAS VEGAS
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State | NV
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Zip | 89106-3810
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Country | US
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Telephone | 702-878-7414
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Fax |
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Provider Business Mailing Address
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Address Line | 3660 SAINT ROSE PKWY UNIT 19202
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City | HENDERSON
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State | NV
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Zip | 89052-4869
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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 | S027261
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 24317
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License Number State | NV
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