MEDICARE: BEVERLY A 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
1	183500000X	Pharmacist	7408	NC

General Provider Information

NPI Number	:	1992707814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEVERLY A CLARK RPH

Provider Business Mailing Address
First Line	:	5021 MONCK CT
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28409-3173
Country	:	US
Telephone Number	:	910-791-5485
Fax Number	:

Provider Business Practice Location Address
First Line	:	5021 MONCK CT
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28409-3173
Country	:	US
Telephone Number	:	910-791-5485
Fax Number	:

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	02/28/2012

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