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General NPI Number Information
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NPI Number | 1922720168
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Entity Type | Individual
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Provider Name | IVETTE CLARK PHARMD
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Gender | Female
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Dates
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Enumeration Date | 09/14/2022
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Last Update Date | 09/14/2022
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Provider Practice Location Address
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Address Line | 3570 S VAL VISTA DR STE 108
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City | GILBERT
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State | AZ
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Zip | 85297-7327
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Country | US
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Telephone | 480-887-0244
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Fax | 480-847-6868
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Provider Business Mailing Address
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Address Line | 909 N HERITAGE
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City | MESA
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State | AZ
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Zip | 85201-3931
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Country | US
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Telephone | 480-334-2820
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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 | S026045
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License Number State | AZ
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