Individual
STACY CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
52482 STATE ROAD 933, SOUTH BEND, IN 46637-3852
(574) 271-0357
Mailing address
52482 STATE ROAD 933, SOUTH BEND, IN 46637-3852
(574) 271-0357
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
26016810
IN
183500000X
Pharmacist
Primary
5302026870
MI
Other
Enumeration date
10/25/2011
Last updated
10/25/2011
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