Provider Demographics
NPI:1871828913
Name:CLARK, ANDREW B (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:B
Last Name:CLARK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 S COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:HARRISONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64701-1634
Mailing Address - Country:US
Mailing Address - Phone:816-380-8037
Mailing Address - Fax:816-887-4330
Practice Address - Street 1:520 S COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:HARRISONVILLE
Practice Address - State:MO
Practice Address - Zip Code:64701-1634
Practice Address - Country:US
Practice Address - Phone:816-380-8037
Practice Address - Fax:816-887-4330
Is Sole Proprietor?:No
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20050244271835P0018X
KS1-139891835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist