Provider Demographics
NPI:1013535194
Name:CLARK, DEBORAH NEIR (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:NEIR
Last Name:CLARK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 ROCKPORT ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIANVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35759-2141
Mailing Address - Country:US
Mailing Address - Phone:256-655-7974
Mailing Address - Fax:
Practice Address - Street 1:2200 SPARKMAN DR NW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35810-3820
Practice Address - Country:US
Practice Address - Phone:256-852-1323
Practice Address - Fax:256-859-5169
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12092183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist