Provider Demographics
NPI:1932484623
Name:CLARK, KAREN M (RPH)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:CLARK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 SAMOSET ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-4822
Mailing Address - Country:US
Mailing Address - Phone:508-591-3031
Mailing Address - Fax:508-591-3034
Practice Address - Street 1:165 SAMOSET ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-4822
Practice Address - Country:US
Practice Address - Phone:508-591-3031
Practice Address - Fax:508-591-3034
Is Sole Proprietor?:No
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23042183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist