Provider Demographics
NPI:1427330695
Name:CLARK, JOSEPH BRIAN (RPH)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:BRIAN
Last Name:CLARK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 QUAIL WALK TRL
Mailing Address - Street 2:
Mailing Address - City:CHAPIN
Mailing Address - State:SC
Mailing Address - Zip Code:29036-9791
Mailing Address - Country:US
Mailing Address - Phone:843-364-2357
Mailing Address - Fax:
Practice Address - Street 1:1000 TANNER FORD BLVD
Practice Address - Street 2:
Practice Address - City:HANAHAN
Practice Address - State:SC
Practice Address - Zip Code:29410
Practice Address - Country:US
Practice Address - Phone:843-553-4077
Practice Address - Fax:843-553-5889
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9591183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist