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NPI Code Detail

MEDICARE: MR. DENNIS RAY CLARK R.PH.

MEDICARE:  MR. DENNIS RAY CLARK  R.PH.
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
1183500000XPharmacist7947OR
21835P0018XPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist7947OR

General Provider Information

NPI Number : 1750629267
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DENNIS RAY CLARK R.PH.
Provider Business Mailing Address
First Line : 162 NE BEACON DR
Second Line : SUITE #109
City : GRANTS PASS
State : OR
Zip : 97526-4260
Country : US
Telephone Number : 541-474-3784
Fax Number :
Provider Business Practice Location Address
First Line : 162 NE BEACON DR
Second Line : SUITE #109
City : GRANTS PASS
State : OR
Zip : 97526-4260
Country : US
Telephone Number : 541-474-3784
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2013
Last Update Date : 01/18/2013

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Directions to “ MR. DENNIS RAY CLARK R.PH.” Practice Location

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