Provider Demographics
NPI:1558731273
Name:CLARK, LORI (RPH)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 E HWY 74 BUSINESS
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:NC
Mailing Address - Zip Code:28379
Mailing Address - Country:US
Mailing Address - Phone:910-582-3570
Mailing Address - Fax:910-582-3574
Practice Address - Street 1:720 E HWY 74 BUSINESS
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-0000
Practice Address - Country:US
Practice Address - Phone:910-582-3570
Practice Address - Fax:910-582-3574
Is Sole Proprietor?:No
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9076183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist