NPI 1437458692

Timothy Allen Clark

Practitioner Pharmacist East Jordan, MI

Practice location

Address: 250 S Lake St, East Jordan, MI 49727-9376
Phone: (231) 536-0901
Fax: (231) 536-3284
Mailing address: 1683 E Gruler Rd, Petoskey, MI 49770-8821

Registered specialties

Pharmacist Primary

Pharmacy Service Providers Taxonomy 183500000X Licence 5302025259 (MI)

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Registry record

NPI: 1437458692
Entity type: Individual
Sex (as registered): Male
NPI issued: 26 Mar 2011
Record last updated: 26 Mar 2011

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.