Provider Demographics
NPI:1972742138
Name:CLARK, JOHN ELBERT (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ELBERT
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 1:12901 BRUCE B. DOWNS BLVD
Mailing Address - Street 2:DEPARTMENT OF PHARMACOTHERAPEUTICS AND CLINICAL RESEARC
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-4749
Mailing Address - Country:US
Mailing Address - Phone:813-974-1305
Mailing Address - Fax:813-905-9890
Practice Address - Street 1:1611 NW 12TH AVE
Practice Address - Street 2:DEPARTMENT OF PHARMACY SERVICES
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1005
Practice Address - Country:US
Practice Address - Phone:305-585-1197
Practice Address - Fax:305-585-7412
Is Sole Proprietor?:No
Enumeration Date:2009-02-11
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS202581835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist