Jacee Clark, PHARMD
Individual provider Active NPI Pharmacist · Ammon, ID
NPI 1043937741 · NPPES record last updated Oct 24, 2022
Key facts
- NPI
- 1043937741
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- P10067 (ID)
- Practice address
- 3160 E 17TH St Ste 164
Ammon, ID 83406-6784 - Phone
- (208) 529-1795
- NPI assigned
- Oct 24, 2022
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P10067 | ID | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | P10067 | ID | Yes |
Addresses
Primary practice location
3160 E 17TH St Ste 164
Ammon, ID 83406-6784
Mailing address
10668 N 36TH E
Idaho Falls, ID 83401-6575
Other practice location 1
124 W Main St
Rexburg, ID 83440-1827
Phone (208) 356-5416
Other providers in Ammon, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 24, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.