Provider Demographics
NPI:1760082382
Name:CLARK, SHARON V (RPH)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:V
Last Name:CLARK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:287 CHAUNCY ST UNIT C301
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-1182
Mailing Address - Country:US
Mailing Address - Phone:508-993-4250
Mailing Address - Fax:508-993-4208
Practice Address - Street 1:42 FAIRHAVEN COMMONS WAY
Practice Address - Street 2:
Practice Address - City:FAIRHAVEN
Practice Address - State:MA
Practice Address - Zip Code:02719-4627
Practice Address - Country:US
Practice Address - Phone:508-993-4250
Practice Address - Fax:508-993-4208
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-01
Last Update Date:2020-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH23116183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist