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NPI Code Detail

MEDICARE: DR. DONALD PATRICK CLARK JR. PHARMD

MEDICARE: DR. DONALD PATRICK CLARK JR. 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
1183500000XPharmacist014085KY

General Provider Information

NPI Number : 1699057943
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DONALD PATRICK CLARK JR. PHARMD
Provider Business Mailing Address
First Line : 1475 DIXIE HWY
Second Line :
City : LOUISVILLE
State : KY
Zip : 40210-1767
Country : US
Telephone Number : 502-776-1840
Fax Number : 502-776-8117
Provider Business Practice Location Address
First Line : 1475 DIXIE HWY
Second Line :
City : LOUISVILLE
State : KY
Zip : 40210-1767
Country : US
Telephone Number : 502-776-1840
Fax Number : 502-776-8117
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2011
Last Update Date : 09/13/2011

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