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NPI Code Detail

MEDICARE: MR. TOM H CLARK RPH

MEDICARE: MR. TOM H CLARK 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
1183500000XPharmacistPS23402FL

General Provider Information

NPI Number : 1558495317
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TOM H CLARK RPH
Provider Business Mailing Address
First Line : 614-112 RED OAK CIRCLE
Second Line :
City : ALTAMONTE SPRINGS
State : FL
Zip : 32701-6344
Country : US
Telephone Number : 407-754-6059
Fax Number :
Provider Business Practice Location Address
First Line : 614-112 RED OAK CIRCLE
Second Line :
City : ALTAMONTE SPRINGS
State : FL
Zip : 32701-6344
Country : US
Telephone Number : 407-754-6059
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/15/2007
Last Update Date : 07/08/2007

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