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NPI Code Detail

MEDICARE: MRS. MITZI CLARK RPH

MEDICARE: MRS. MITZI CLARK RPH
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
1183500000XPharmacist30439TX

General Provider Information

NPI Number : 1780999748
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MITZI CLARK RPH
Provider Business Mailing Address
First Line : 6520 FRATT RD
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78218-4402
Country : US
Telephone Number : 210-938-4536
Fax Number : 210-938-4571
Provider Business Practice Location Address
First Line : 6520 FRATT RD
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78218-4402
Country : US
Telephone Number : 210-938-4536
Fax Number : 210-938-4571
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2010
Last Update Date : 08/16/2010

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Directions to “ MRS. MITZI CLARK RPH” Practice Location

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