Provider Demographics
NPI:1407188691
Name:ADAMS, CLARK ALAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:CLARK
Middle Name:ALAN
Last Name:ADAMS
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 1:3141 OLD FARM RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-1250
Mailing Address - Country:US
Mailing Address - Phone:810-230-1918
Mailing Address - Fax:810-235-8181
Practice Address - Street 1:G3083 MILLER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-1353
Practice Address - Country:US
Practice Address - Phone:810-238-0489
Practice Address - Fax:810-235-8118
Is Sole Proprietor?:No
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302023071183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist