Individual
SEAN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2407 STRINGER GAP RD, GRANTS PASS, OR 97527-9573
(541) 660-7657
Mailing address
2407 STRINGER GAP RD, GRANTS PASS, OR 97527-9573
(541) 660-7657
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
0015445
OR
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Primary
0015445
OR
Other
Enumeration date
10/28/2016
Last updated
02/05/2019
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