Provider Demographics
NPI:1013993724
Name:CLARK, LINDSEY RAE
Entity Type:Individual
Prefix:MRS
First Name:LINDSEY
Middle Name:RAE
Last Name:CLARK
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:LINDSEY
Other - Middle Name:RAE
Other - Last Name:BERGESON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2222 32ND AVE W
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98199-4044
Mailing Address - Country:US
Mailing Address - Phone:206-282-2881
Mailing Address - Fax:206-282-2817
Practice Address - Street 1:2222 32ND AVE W
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98199-4044
Practice Address - Country:US
Practice Address - Phone:206-282-2881
Practice Address - Fax:206-282-2817
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA00060731183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician