Provider Demographics
NPI:1588037006
Name:CLARK, FAITH MARRISSA (RPH)
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:MARRISSA
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 1:8000 TOWN DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-2828
Mailing Address - Country:US
Mailing Address - Phone:919-424-6614
Mailing Address - Fax:919-424-6245
Practice Address - Street 1:8000 TOWN DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-2828
Practice Address - Country:US
Practice Address - Phone:919-424-6614
Practice Address - Fax:919-424-6245
Is Sole Proprietor?:No
Enumeration Date:2015-11-05
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17078183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist