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NPI Code Detail

MEDICARE: STACY R CLARK PHARMD

MEDICARE: STACY R CLARK PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1063342541
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACY R CLARK PHARMD
Provider Business Mailing Address
First Line : 5908 ARDEN DR
Second Line :
City : CLEMMONS
State : NC
Zip : 27012-9407
Country : US
Telephone Number : 336-528-0258
Fax Number :
Provider Business Practice Location Address
First Line : 1970 ROANOKE BLVD
Second Line :
City : SALEM
State : VA
Zip : 24153-6404
Country : US
Telephone Number : 540-982-2463
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2026
Last Update Date : 05/19/2026

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Directions to “ STACY R CLARK PHARMD” Practice Location

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