Individual
MR. LEWIS GRANT CLARK III
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PHARMACIST
Contact information
Practice address
815 SAINT MARYS DR, WAYCROSS, GA 31501-3234
(912) 338-0688
Mailing address
815 SAINT MARYS DR, WAYCROSS, GA 31501-3234
(912) 338-0688
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
GA 11041
GA
Other
Enumeration date
11/01/2005
Last updated
07/08/2007
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