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General NPI Number Information
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NPI Number | 1851099642
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Entity Type | Individual
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Provider Name | MICHAEL JOSEPH CLARK
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Gender | Male
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Dates
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Enumeration Date | 02/21/2023
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Last Update Date | 02/21/2023
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Provider Practice Location Address
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Address Line | 14447 COUNTRY WALK DR
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City | MIAMI
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State | FL
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Zip | 33186-8104
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Country | US
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Telephone | 305-251-7414
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Fax | 305-251-3878
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Provider Business Mailing Address
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Address Line | 15641 SW 86TH AVE
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City | PALMETTO BAY
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State | FL
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Zip | 33157-2142
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Country | US
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Telephone | 305-251-7414
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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 | PS17444
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License Number State | FL
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