Provider Demographics
NPI:1972819498
Name:CLARK, LINDA C (RPH)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:C
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 1:36019 HWY 27
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-3740
Mailing Address - Country:US
Mailing Address - Phone:863-421-0639
Mailing Address - Fax:863-421-0578
Practice Address - Street 1:36019 HWY 27
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-3740
Practice Address - Country:US
Practice Address - Phone:863-421-0639
Practice Address - Fax:863-421-0578
Is Sole Proprietor?:No
Enumeration Date:2010-08-21
Last Update Date:2010-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS23051183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist