Individual
JEFFREY CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5353 YELLOWSTONE RD, CHEYENNE, WY 82009-4178
(307) 532-6178
Mailing address
5712 KENNEDY DR, CHEYENNE, WY 82001-7422
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
1633T
WY
Other
Enumeration date
02/27/2013
Last updated
02/27/2013
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