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NPI Code Detail

MEDICARE: DR. TERRY ROBERT CLARK PHARM D

MEDICARE: DR. TERRY ROBERT CLARK PHARM D
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
1183500000XPharmacistPH00010513WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PH00010513OTHERWALICENSE

General Provider Information

NPI Number : 1245221324
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TERRY ROBERT CLARK PHARM D
Provider Business Mailing Address
First Line : 17741 MANASTASH RD
Second Line :
City : ELLENSBURG
State : WA
Zip : 98926-9119
Country : US
Telephone Number : 509-962-2812
Fax Number :
Provider Business Practice Location Address
First Line : 402 S 4TH AVE STE E127
Second Line :
City : YAKIMA
State : WA
Zip : 98902-3546
Country : US
Telephone Number : 509-899-4892
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/28/2005
Last Update Date : 03/07/2023

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