Individual
MS. KELLY DAWN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
1802 S MATTIS AVE, CHAMPAIGN, IL 61821-5923
(217) 326-1399
Mailing address
3405 COUNTRY BEND PL, CHAMPAIGN, IL 61822-6155
(217) 355-9363
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
—
IL
Other
Enumeration date
03/29/2007
Last updated
07/08/2007
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