Provider Demographics
NPI:1780824029
Name:CLARK, KAREN CHAVIS (RPH)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:CHAVIS
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:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:BISCOE
Mailing Address - State:NC
Mailing Address - Zip Code:27209-0249
Mailing Address - Country:US
Mailing Address - Phone:910-428-1150
Mailing Address - Fax:910-428-1155
Practice Address - Street 1:2295 NC HIGHWAY 24 27 E
Practice Address - Street 2:
Practice Address - City:BISCOE
Practice Address - State:NC
Practice Address - Zip Code:27209
Practice Address - Country:US
Practice Address - Phone:910-428-1150
Practice Address - Fax:910-428-1155
Is Sole Proprietor?:No
Enumeration Date:2009-02-26
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12560183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist