Provider Demographics
NPI:1255628590
Name:CLARK, ASHLEY LOUISE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:LOUISE
Last Name:CLARK
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 1:140 ACKLINS CIR APT 110
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32119-9771
Mailing Address - Country:US
Mailing Address - Phone:386-323-7500
Mailing Address - Fax:
Practice Address - Street 1:551 NATIONAL HEALTHCARE DRIVE
Practice Address - Street 2:DAYTONA BEACH VA OUTPATIENT CLINIC
Practice Address - City:DAYTONA BEAC
Practice Address - State:FL
Practice Address - Zip Code:32608-1135
Practice Address - Country:US
Practice Address - Phone:352-379-6062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS464011835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric