Provider Demographics
NPI:1518377803
Name:CLARKE, AMY ANN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:ANN
Last Name:CLARKE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1790 AIRLINE HWY
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-5621
Mailing Address - Country:US
Mailing Address - Phone:831-638-4824
Mailing Address - Fax:
Practice Address - Street 1:1790 AIRLINE HWY
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-5621
Practice Address - Country:US
Practice Address - Phone:831-638-4824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70213183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist