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NPI Code Detail

MEDICARE: LEXUS CLARK

MEDICARE: LEXUS 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
1183500000XPharmacist0230031423VA

General Provider Information

NPI Number : 1689251423
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEXUS CLARK
Provider Business Mailing Address
First Line : 5700 HOPKINS RD
Second Line :
City : NORTH CHESTERFIELD
State : VA
Zip : 23234-6631
Country : US
Telephone Number : 804-253-0759
Fax Number : 804-253-9788
Provider Business Practice Location Address
First Line : 5700 HOPKINS RD
Second Line :
City : NORTH CHESTERFIELD
State : VA
Zip : 23234-6631
Country : US
Telephone Number : 804-253-0759
Fax Number : 804-253-9788
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2021
Last Update Date : 03/26/2021

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Directions to “ LEXUS CLARK ” Practice Location

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