Provider Demographics
NPI:1346688546
Name:CLARK, LYNN (RPH)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:PO BOX 765311
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75376-5311
Mailing Address - Country:US
Mailing Address - Phone:972-998-6901
Mailing Address - Fax:
Practice Address - Street 1:400 N SAINT PAUL ST STE 1205
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-6869
Practice Address - Country:US
Practice Address - Phone:855-994-0100
Practice Address - Fax:972-803-6626
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34339183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist