Derek Clark, PharmD
Pharmacist in Prescott Valley, AZ. Individual provider (NPI-1).
NPI number1124452073
StatusActive
Last updated in NPPESAug 28, 2013
Details
- NPI
- 1124452073
- Entity type
- Individual (NPI-1)
- Name
- Derek Clark
- Credential
- PharmD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Aug 28, 2013
- Last updated
- Aug 28, 2013
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 183500000X | Pharmacist | S020113 | AZ | Yes |
Practice location
3100 N Glassford Hill RdPrescott Valley, AZ 86314-2285
Phone 928-445-0607
Mailing address
3100 N Glassford Hill RdPrescott Valley, AZ 86314-2285
Phone 928-445-0607
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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All 52 Pharmacist providers in Prescott Valley · All 972 providers in Prescott Valley
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