Individual
MARY E CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPHT
Contact information
Practice address
1105 MICHIGAN AVE, OROFINO, ID 83544-9005
(208) 476-3600
Mailing address
89 SUNNYSIDE BENCH RD, LENORE, ID 83541-5028
(208) 451-6535
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
30178781
ID
Other
Enumeration date
09/25/2021
Last updated
09/25/2021
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