MEDICARE: ELYSIA ANN RASHID-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	051298138	IL
2	183500000X	Pharmacist	22304	IA

General Provider Information

NPI Number	:	1669140950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELYSIA ANN RASHID-CLARK PHARMD

Provider Business Mailing Address
First Line	:	2520 ELM ST
Second Line	:
City	:	DAVENPORT
State	:	IA
Zip	:	52803-2307
Country	:	US
Telephone Number	:	319-471-5400
Fax Number	:

Provider Business Practice Location Address
First Line	:	2404 AVENUE L
Second Line	:
City	:	FORT MADISON
State	:	IA
Zip	:	52627-3933
Country	:	US
Telephone Number	:	319-372-2300
Fax Number	:

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

Provider Enumeration Date	:	09/01/2021
Last Update Date	:	10/26/2021

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Directions to “ ELYSIA ANN RASHID-CLARK PHARMD” Practice Location

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