MEDICARE: DR. ADAM 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	1835P1200X	Pharmacotherapy Pharmacist	PS0032546	FL

General Provider Information

NPI Number	:	1669469342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADAM CLARK

Provider Business Mailing Address
First Line	:	1920 NE 7TH TER
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32609-3749
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1920 NE 7TH TER
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32609-3749
Country	:	US
Telephone Number	:	352-376-1611
Fax Number	:

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

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	07/08/2007

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Directions to “ DR. ADAM CLARK ” Practice Location

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