Provider Demographics
NPI:1376154435
Name:CLARK, JAMES LINDSAY (PHARMD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:LINDSAY
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 1:201 S 1300 E STE 101
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-2608
Mailing Address - Country:US
Mailing Address - Phone:801-736-9309
Mailing Address - Fax:801-736-9311
Practice Address - Street 1:201 S 1300 E STE 101
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-2608
Practice Address - Country:US
Practice Address - Phone:801-736-9309
Practice Address - Fax:801-736-9311
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8381162183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist