Individual
TYLER TODD CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1130 W FRONTAGE RD, OWATONNA, MN 55060-5662
(507) 451-3323
Mailing address
325 HOFFMAN DR APT 312, OWATONNA, MN 55060-3282
(320) 515-1620
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
124582
MN
Other
Enumeration date
09/24/2020
Last updated
09/24/2020
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