Provider Demographics
NPI:1326382151
Name:CLARK, ROBERT CORNELIUS III (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CORNELIUS
Last Name:CLARK
Suffix:III
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 1:6690 NOLENSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-8803
Mailing Address - Country:US
Mailing Address - Phone:615-941-7643
Mailing Address - Fax:
Practice Address - Street 1:6690 NOLENSVILLE RD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-8803
Practice Address - Country:US
Practice Address - Phone:615-941-7643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-16
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36882183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist