MEDICARE: RUTH CLARK

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
1	183500000X	Pharmacist	17905	IA

General Provider Information

NPI Number	:	1114987575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUTH CLARK

Provider Business Mailing Address
First Line	:	724 4TH AVE N
Second Line	:
City	:	MOUNT VERNON
State	:	IA
Zip	:	52314-1105
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	113 1ST ST E
Second Line	:
City	:	MOUNT VERNON
State	:	IA
Zip	:	52314-1422
Country	:	US
Telephone Number	:	319-895-6248
Fax Number	:	319-895-6991

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2006
Last Update Date	:	07/08/2007

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Directions to “ RUTH CLARK ” Practice Location

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