Individual
MR. ROSS WILLIAM CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
7025 N WICKHAM RD, SUITE 113, MELBOURNE, LA 32940
(321) 253-3535
Mailing address
1697A HWY A.1.A., SATELLITE BEACH, LA 32937
(321) 917-7323
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PS0025442
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PS0025442
PHARMACY LICENSE
FL
Enumeration date
12/11/2006
Last updated
07/08/2007
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