Individual
JOE BOAZ CLARK IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
640 E MAIN ST, SUN PRAIRIE, WI 53590-9696
(608) 837-3821
Mailing address
640 E MAIN ST, SUN PRAIRIE, WI 53590-9696
(608) 837-3821
Taxonomy
Speciality
Code
Description
License number
State
1835P2201X
Ambulatory Care Pharmacist
Primary
17466-40
WI
Other
Enumeration date
11/17/2021
Last updated
11/17/2021
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