Individual
MR. MICHAEL JOHN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
1979 LIME KILN RD, GREEN BAY, WI 54311-6219
(920) 288-0638
(920) 288-0645
Mailing address
1979 LIME KILN RD, GREEN BAY, WI 54311-6219
(920) 288-0638
(920) 288-0645
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
12691-040
WI
Other
Enumeration date
10/24/2011
Last updated
10/24/2011
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