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General NPI Number Information
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NPI Number | 1942531868
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Entity Type | Individual
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Provider Name | JUSTIN CLARK PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 01/15/2010
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Last Update Date | 01/05/2023
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Provider Practice Location Address
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Address Line | 860 POTOMAC CIR
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City | AURORA
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State | CO
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Zip | 80011-6714
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Country | US
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Telephone | 720-777-0300
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Fax | 720-478-7400
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Provider Business Mailing Address
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Address Line | 860 POTOMAC CIR
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City | AURORA
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State | CO
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Zip | 80011-6714
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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 | RP00007152
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License Number State | NM
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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 | S016609
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH.0021616
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License Number State | CO
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