Provider Demographics
NPI:1063760874
Name:CLARK, SUMMER (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:SUMMER
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 CRESTDALE RD.
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105
Mailing Address - Country:US
Mailing Address - Phone:919-757-5405
Mailing Address - Fax:843-216-7028
Practice Address - Street 1:5810 HIGHLAND SHOPPES DR.
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-1138
Practice Address - Country:US
Practice Address - Phone:704-875-7128
Practice Address - Fax:704-875-7378
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13722183500000X
NC22619183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist