Individual
MR. TONY DALE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
12200 W 95TH ST, LENEXA, KS 66215-3806
(913) 894-2093
(913) 894-8167
Mailing address
6552 BARTH RD, SHAWNEE, KS 66226-3510
(913) 669-3091
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
1-15358
KS
Other
Enumeration date
12/21/2020
Last updated
12/21/2020
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