Provider Demographics
NPI:1215494083
Name:CLARK, ASHLEY TAYLOR (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:TAYLOR
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 1:524 E DON TYLER AVE
Mailing Address - Street 2:
Mailing Address - City:DEWEY
Mailing Address - State:OK
Mailing Address - Zip Code:74029-2518
Mailing Address - Country:US
Mailing Address - Phone:918-534-2262
Mailing Address - Fax:918-534-3208
Practice Address - Street 1:524 E DON TYLER AVE
Practice Address - Street 2:
Practice Address - City:DEWEY
Practice Address - State:OK
Practice Address - Zip Code:74029-2518
Practice Address - Country:US
Practice Address - Phone:918-534-2262
Practice Address - Fax:918-534-3208
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-16745183500000X
OK16982183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist