Individual
SHERRI LAVERNE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPH
Contact information
Practice address
1205 W MAIN ST, COLLINSVILLE, OK 74021-3114
(918) 371-2547
(918) 371-0268
Mailing address
PO BOX 82, COLLINSVILLE, OK 74021-0082
(918) 371-2547
(918) 371-0268
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
9949
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9949
PHARMACIST LICENSE
OK
Enumeration date
12/04/2006
Last updated
07/08/2007
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