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Individual
MICHAEL STUART CLARK I
Active
Individual
MICHAEL STUART CLARK I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
05857
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04686806
—
MS
01
—
09058522
MEDICAID DME
MS
01
—
2521513
NCPDP
MS
Enumeration date
09/21/2006
Last updated
07/08/2007
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