Individual
MR. DOUGLAS LEE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
9750 HIGHWAY 70, MINOCQUA, WI 54548-9753
(715) 356-9449
(715) 356-0011
Mailing address
PO BOX 50, MINOCQUA, WI 54548-0050
(715) 356-9449
(715) 356-0011
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
10717-40
WI
Other
Enumeration date
10/19/2012
Last updated
10/19/2012
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