Individual
MISS MATILDA ANNE CLARK
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
RPH.
Contact information
Practice address
620 JOHN PAUL JONES CR, PORTSMOUTH, VA 23708-2197
(757) 953-0284
Mailing address
515 PARKER RD, CHESAPEAKE, VA 23322-5827
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0202005078
VA
183500000X
Pharmacist
08296
NC
183500000X
Pharmacist
RPH015157
GA
Other
Enumeration date
01/17/2006
Last updated
07/08/2007
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