Individual
REBECCA MAE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARM. D.
Contact information
Practice address
5804 1ST AVE S, BIRMINGHAM, AL 35212-2524
(205) 380-9540
Mailing address
125 MAPLE LEAF TRL, WILSONVILLE, AL 35186-5420
(850) 501-1783
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
20977
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20977
PHARMACIST
AL
Enumeration date
09/25/2019
Last updated
09/25/2019
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