Provider Demographics
NPI:1942212477
Name:CLARK, AARON CHRISTOPHER (DPH)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:CHRISTOPHER
Last Name:CLARK
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1042 MOUNT LEBANON RD
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-5613
Mailing Address - Country:US
Mailing Address - Phone:865-984-3359
Mailing Address - Fax:
Practice Address - Street 1:129 GILL ST
Practice Address - Street 2:
Practice Address - City:ALCOA
Practice Address - State:TN
Practice Address - Zip Code:37701-2656
Practice Address - Country:US
Practice Address - Phone:865-984-7704
Practice Address - Fax:865-984-6220
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9817183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist