Provider Demographics
NPI:1457916546
Name:CLARK, JULIANNA K (PHARMD)
Entity Type:Individual
Prefix:
First Name:JULIANNA
Middle Name:K
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 1:15124 SE YAMHILL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-2949
Mailing Address - Country:US
Mailing Address - Phone:510-304-3086
Mailing Address - Fax:
Practice Address - Street 1:16261 HIGHWAY 101 S
Practice Address - Street 2:
Practice Address - City:HARBOR
Practice Address - State:OR
Practice Address - Zip Code:97415-9499
Practice Address - Country:US
Practice Address - Phone:541-469-3121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-05
Last Update Date:2019-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0017134183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist