Provider Demographics
NPI:1417994054
Name:CLARK, WILLIAM N (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:N
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 1:825 W STIRRUP DR
Mailing Address - Street 2:
Mailing Address - City:SAFFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85546-3537
Mailing Address - Country:US
Mailing Address - Phone:928-348-9272
Mailing Address - Fax:
Practice Address - Street 1:1520 W THATCHER BLVD
Practice Address - Street 2:
Practice Address - City:SAFFORD
Practice Address - State:AZ
Practice Address - Zip Code:85546-3309
Practice Address - Country:US
Practice Address - Phone:928-428-6366
Practice Address - Fax:928-428-6025
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13729183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist