Individual
MR. KENNETH R CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4211 HOSPITAL ST STE 104, PASCAGOULA, MS 39581-5310
(228) 762-1940
(228) 762-7786
Mailing address
2415 BEACH BLVD, PASCAGOULA, MS 39567-1422
(228) 623-1392
(228) 762-7786
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
E-06773
MS
Other
Enumeration date
04/03/2007
Last updated
11/15/2017
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