Provider Demographics
NPI:1407142524
Name:CLARK, HOWARD RUSSELL (RPH)
Entity Type:Individual
Prefix:MR
First Name:HOWARD
Middle Name:RUSSELL
Last Name:CLARK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3625 S COLLEGE RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-2003
Mailing Address - Country:US
Mailing Address - Phone:910-395-8248
Mailing Address - Fax:910-452-1247
Practice Address - Street 1:3625 S COLLEGE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-2003
Practice Address - Country:US
Practice Address - Phone:910-395-8248
Practice Address - Fax:910-452-1247
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC07422183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist