Provider Demographics
NPI:1710272315
Name:CLARK, KAREN LEA (PD)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:LEA
Last Name:CLARK
Suffix:
Gender:F
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 E HIGHLAND DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-6382
Mailing Address - Country:US
Mailing Address - Phone:870-934-9668
Mailing Address - Fax:870-934-9668
Practice Address - Street 1:3000 E HIGHLAND DR
Practice Address - Street 2:SUITE A
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-6382
Practice Address - Country:US
Practice Address - Phone:870-934-9668
Practice Address - Fax:870-934-9668
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD07963183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist