MEDICARE: ROBYN ELIZABETH CLUCK

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	18073	NV

General Provider Information

NPI Number	:	1992335996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBYN ELIZABETH CLUCK

Provider Business Mailing Address
First Line	:	2255 E CENTENNIAL PKWY
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-5601
Country	:	US
Telephone Number	:	702-633-6222
Fax Number	:	702-633-8849

Provider Business Practice Location Address
First Line	:	2255 E CENTENNIAL PKWY
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-5601
Country	:	US
Telephone Number	:	702-633-6222
Fax Number	:	702-633-8849

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

Provider Enumeration Date	:	01/19/2020
Last Update Date	:	01/19/2020

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Directions to “ ROBYN ELIZABETH CLUCK ” Practice Location

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