MEDICARE: MICHELE JEAN 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
1	183500000X	Pharmacist	03117511	OH

General Provider Information

NPI Number	:	1598437204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELE JEAN CLARK

Provider Business Mailing Address
First Line	:	2173 STRINGTOWN RD
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123
Country	:	US
Telephone Number	:	614-875-8591
Fax Number	:	614-875-8407

Provider Business Practice Location Address
First Line	:	2173 STRINGTOWN RD
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-2989
Country	:	US
Telephone Number	:	614-875-8591
Fax Number	:	614-875-8407

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

Provider Enumeration Date	:	09/30/2021
Last Update Date	:	09/30/2021

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Directions to “ MICHELE JEAN CLARK ” Practice Location

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