Provider Demographics
NPI:1144619040
Name:CLARK, DEIRDRE HEMPHILL (RPH)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:HEMPHILL
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 1:95 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-5948
Mailing Address - Country:US
Mailing Address - Phone:207-783-0661
Mailing Address - Fax:
Practice Address - Street 1:95 SPRING ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-5948
Practice Address - Country:US
Practice Address - Phone:207-783-0661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR4126183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist