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Individual

TRACY M CLARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CPHT

Contact information

Practice address
3409 WORTH ST, 725, DALLAS, TX 75246-2029
(214) 276-5616
Mailing address
254 E OATES RD APT 101, GARLAND, TX 75043-3454
(469) 648-8444

Taxonomy

Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
119588
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
119588
TEXAS STATE BOARD OF PHARMACY
TX
01
170109717629639
PHARMACY TECHNICIAN CERTIFICATION BOARD
TX
Enumeration date
04/10/2007
Last updated
02/08/2016
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