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Individual

MR. DENNIS RAY CLARK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
R.PH.

Contact information

Practice address
162 NE BEACON DR, SUITE #109, GRANTS PASS, OR 97526-4260
(541) 474-3784
Mailing address
162 NE BEACON DR, SUITE #109, GRANTS PASS, OR 97526-4260
(541) 474-3784

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
7947
OR
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Primary
7947
OR

Other

Enumeration date
01/18/2013
Last updated
01/18/2013
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