MEDICARE: DR. MADELINE ANN 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
1	183500000X	Pharmacist	32366	NC

General Provider Information

NPI Number	:	1518647353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MADELINE ANN CLARK PHARMD

Provider Business Mailing Address
First Line	:	1433 MAHONIA DR
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28027-5365
Country	:	US
Telephone Number	:	318-853-5458
Fax Number	:

Provider Business Practice Location Address
First Line	:	215 E JEFFERSON ST
Second Line	:
City	:	MONROE
State	:	NC
Zip	:	28112-4865
Country	:	US
Telephone Number	:	704-283-8131
Fax Number	:

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

Provider Enumeration Date	:	07/18/2023
Last Update Date	:	03/10/2026

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