Individual
MICHAEL ERICSON CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
2062 WHISKEY RD, AIKEN, SC 29803-6183
(803) 648-2339
(803) 502-0971
Mailing address
2062 WHISKEY RD, AIKEN, SC 29803-6183
(803) 648-2339
(803) 502-0971
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
13704
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13704
PHARMACIST LICENSE
SC
Enumeration date
04/28/2012
Last updated
07/21/2022
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