Provider Demographics
NPI:1881963593
Name:CLARK, SEVETTE (PHARMD)
Entity type:Individual
Prefix:MS
First Name:SEVETTE
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:SEVETTE
Other - Middle Name:
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:8301 LEVEE LN
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33637-6312
Mailing Address - Country:US
Mailing Address - Phone:813-989-0518
Mailing Address - Fax:
Practice Address - Street 1:11115 MARTIN LUTHER KING BLVD
Practice Address - Street 2:
Practice Address - City:SEFFNER
Practice Address - State:FL
Practice Address - Zip Code:33584-8378
Practice Address - Country:US
Practice Address - Phone:813-689-4049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-26
Last Update Date:2011-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40280183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist