Individual
JACEE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
3160 E 17TH ST STE 164, AMMON, ID 83406-6784
(208) 529-1795
Mailing address
10668 N 36TH E, IDAHO FALLS, ID 83401-6575
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P10067
ID
Other
Enumeration date
10/24/2022
Last updated
10/24/2022
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