MEDICARE: LINDA C 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
1	183500000X	Pharmacist	PS23051	FL

General Provider Information

NPI Number	:	1972819498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA C CLARK R.PH.

Provider Business Mailing Address
First Line	:	36019 HWY 27
Second Line	:
City	:	HAINES CITY
State	:	FL
Zip	:	33844-3740
Country	:	US
Telephone Number	:	863-421-0639
Fax Number	:	863-421-0578

Provider Business Practice Location Address
First Line	:	36019 HWY 27
Second Line	:
City	:	HAINES CITY
State	:	FL
Zip	:	33844-3740
Country	:	US
Telephone Number	:	863-421-0639
Fax Number	:	863-421-0578

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

Provider Enumeration Date	:	08/21/2010
Last Update Date	:	08/21/2010

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