Provider Demographics
NPI:1568785459
Name:CLARK, JOSHUA JAMES (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:JAMES
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 1:131 COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:BERWICK
Mailing Address - State:PA
Mailing Address - Zip Code:18603-2001
Mailing Address - Country:US
Mailing Address - Phone:570-204-0600
Mailing Address - Fax:
Practice Address - Street 1:131 COLUMBIA AVENUE
Practice Address - Street 2:
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603-2001
Practice Address - Country:US
Practice Address - Phone:570-204-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-05
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP443770183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist