Provider Demographics
NPI:1841580586
Name:CLARK, JOHN ALAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ALAN
Last Name:CLARK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:A
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:1900 ARGILLITE RD
Mailing Address - Street 2:
Mailing Address - City:FLATWOODS
Mailing Address - State:KY
Mailing Address - Zip Code:41139-1616
Mailing Address - Country:US
Mailing Address - Phone:606-836-2498
Mailing Address - Fax:
Practice Address - Street 1:1900 ARGILLITE RD
Practice Address - Street 2:
Practice Address - City:FLATWOODS
Practice Address - State:KY
Practice Address - Zip Code:41139-1616
Practice Address - Country:US
Practice Address - Phone:606-836-2498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY006468183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist