Provider Demographics
NPI:1720064447
Name:CLARK, RAYMOND LEE JR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:LEE
Last Name:CLARK
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1003 CHRISTINE AVE APT 103
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-5778
Mailing Address - Country:US
Mailing Address - Phone:256-689-2083
Mailing Address - Fax:
Practice Address - Street 1:1316 NOBLE ST STE 1-C
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36201-4643
Practice Address - Country:US
Practice Address - Phone:256-439-6393
Practice Address - Fax:256-235-2751
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL154391835P1200X
MI53020275221835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy