Provider Demographics
NPI:1184905374
Name:CLARK, SHARON REDMAN
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:REDMAN
Last Name:CLARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2S406 BURNING TRL
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-5906
Mailing Address - Country:US
Mailing Address - Phone:630-665-0542
Mailing Address - Fax:
Practice Address - Street 1:2986 KIRK RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60502-6000
Practice Address - Country:US
Practice Address - Phone:630-375-0570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051033626183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist