Provider Demographics
NPI:1598361479
Name:CLARK, MARQUIVIA D (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARQUIVIA
Middle Name:D
Last Name:CLARK
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 1:4240 NARROW LANE RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36111-2650
Mailing Address - Country:US
Mailing Address - Phone:334-284-3298
Mailing Address - Fax:334-284-3816
Practice Address - Street 1:4240 NARROW LANE RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36111-2650
Practice Address - Country:US
Practice Address - Phone:334-284-3298
Practice Address - Fax:334-284-3816
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19157183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL19157OtherALBOP