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NPI Code Detail

MEDICARE: PAMELA CLARK

MEDICARE: PAMELA 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
11835P1200XPharmacotherapy Pharmacist5302026150MI

General Provider Information

NPI Number : 1306256920
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAMELA CLARK
Provider Business Mailing Address
First Line : 2980 WILDER RD
Second Line :
City : BAY CITY
State : MI
Zip : 48706-9213
Country : US
Telephone Number : 989-667-9533
Fax Number : 989-667-9565
Provider Business Practice Location Address
First Line : 2980 WILDER RD
Second Line :
City : BAY CITY
State : MI
Zip : 48706-9213
Country : US
Telephone Number : 989-667-9533
Fax Number : 989-667-9565
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2014
Last Update Date : 05/05/2014

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Directions to “ PAMELA CLARK ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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