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NPI Code Detail

MEDICARE: ELIZABETH KAITLYN CLARK PHARMD RPH

MEDICARE: ELIZABETH KAITLYN CLARK PHARMD RPH
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
1183500000XPharmacist5302039919MI

General Provider Information

NPI Number : 1467076224
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH KAITLYN CLARK PHARMD RPH
Provider Business Mailing Address
First Line : 5477 EXODUS DR
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49684-8353
Country : US
Telephone Number : 231-715-0090
Fax Number :
Provider Business Practice Location Address
First Line : 1029 S M 37
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49685-8508
Country : US
Telephone Number : 231-943-3147
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/07/2020
Last Update Date : 06/07/2020

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