Most Relevant Information
Provider Data
| NPI Number: | 1003071150 |
| Provider Name: | KELLY RAE CLARK PHARM.D. |
| Entity Type: | Individual |
| Taxonomy Code: | 1835P1300X |
| Specialty: | Pharmacist |
| License Number: | 41224 |
Most Important Dates
| Enumeration Date: | 07/28/2008 |
| Last Updated: | 07/28/2008 |
Provider Practice Location
130 W KINGSBRIDGE RD
BRONX
NY
104683904
Practice Location Phone/Fax
| Phone: | 7185849000 |
| Fax: |
Provider Mailing Location
130 W KINGSBRIDGE RD
BRONX
NY
104683904
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |