Provider Demographics
NPI:1982658209
Name:CLARKE, SANDRA PHILLIPPI (PHARMD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:PHILLIPPI
Last Name:CLARKE
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 1:185 STAFFORD UMBERGER RD
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-4439
Mailing Address - Country:US
Mailing Address - Phone:276-228-5940
Mailing Address - Fax:276-228-9292
Practice Address - Street 1:450 W MONROE ST
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-2236
Practice Address - Country:US
Practice Address - Phone:276-223-0558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202206588183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist