Provider Demographics
NPI:1780985473
Name:CLARK, JULIENNE E (PHARMD)
Entity type:Individual
Prefix:MS
First Name:JULIENNE
Middle Name:E
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 1:4108 OLD OAK DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-1931
Mailing Address - Country:US
Mailing Address - Phone:501-673-4400
Mailing Address - Fax:
Practice Address - Street 1:13907 HIGH RD
Practice Address - Street 2:
Practice Address - City:MABELVALE
Practice Address - State:AR
Practice Address - Zip Code:72103-3212
Practice Address - Country:US
Practice Address - Phone:501-455-1086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR10339183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist