Provider Demographics
NPI:1760887723
Name:CLARK, NED JR (RPH)
Entity Type:Individual
Prefix:
First Name:NED
Middle Name:
Last Name:CLARK
Suffix:JR
Gender:M
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:PO BOX 337
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:NC
Mailing Address - Zip Code:27868-0337
Mailing Address - Country:US
Mailing Address - Phone:252-908-3776
Mailing Address - Fax:
Practice Address - Street 1:261 PRIVATE LN
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:NC
Practice Address - Zip Code:27856-8114
Practice Address - Country:US
Practice Address - Phone:252-908-3776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-01
Last Update Date:2014-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7005183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist