Provider Demographics
NPI:1275815615
Name:CLARK, GARRREK LINDEN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GARRREK
Middle Name:LINDEN
Last Name:CLARK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 DRAPER PKWY
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-8567
Mailing Address - Country:US
Mailing Address - Phone:801-571-0378
Mailing Address - Fax:
Practice Address - Street 1:1311 DRAPER PKWY
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-8567
Practice Address - Country:US
Practice Address - Phone:801-571-0378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5485441-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist