MEDICARE: DR. RAYMOND LEE CLARK JR. PHARM.D.

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	15439	AL
2	1835P1200X	Pharmacotherapy Pharmacist	5302027522	MI

General Provider Information

NPI Number	:	1720064447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAYMOND LEE CLARK JR. PHARM.D.

Provider Business Mailing Address
First Line	:	1003 CHRISTINE AVE APT 103
Second Line	:
City	:	ANNISTON
State	:	AL
Zip	:	36207-5778
Country	:	US
Telephone Number	:	256-689-2083
Fax Number	:

Provider Business Practice Location Address
First Line	:	1316 NOBLE ST STE 1-C
Second Line	:
City	:	ANNISTON
State	:	AL
Zip	:	36201-4643
Country	:	US
Telephone Number	:	256-439-6393
Fax Number	:	256-235-2751

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

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	10/09/2019

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