Provider Demographics
NPI:1699890202
Name:CLARK, SHAMIKI RENEE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SHAMIKI
Middle Name:RENEE
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 1:7357 PENFIELD CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-4775
Mailing Address - Country:US
Mailing Address - Phone:407-532-6653
Mailing Address - Fax:
Practice Address - Street 1:1531 E SILVER STAR RD
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-2553
Practice Address - Country:US
Practice Address - Phone:407-299-6960
Practice Address - Fax:407-299-7552
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0036128183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0556050612Medicare ID - Type Unspecified