Provider Demographics
NPI:1922121326
Name:CLARK, ASHLEY SUZANNE (PHARMD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:SUZANNE
Last Name:CLARK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2447 CHELTENHAM RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3202
Mailing Address - Country:US
Mailing Address - Phone:419-531-3608
Mailing Address - Fax:
Practice Address - Street 1:5224 DORR ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-3602
Practice Address - Country:US
Practice Address - Phone:419-531-2115
Practice Address - Fax:419-531-5946
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-27477183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist