Active NPI
Derek Clark, PHARMD
- Pharmacist
- Prescott Valley, AZ
National Provider Identifier
1124452073
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- S020113
- Practice address
- 3100 N Glassford Hill Rd
Prescott Valley, AZ 86314-2285 - Phone
- (928) 445-0607
- NPI assigned
- Aug 28, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | S020113 | AZ | Primary |
Addresses
Primary practice location
3100 N Glassford Hill Rd
Prescott Valley, AZ 86314-2285
Mailing address
3100 N Glassford Hill Rd
Prescott Valley, AZ 86314-2285
Phone (928) 445-0607
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S020113 | AZ | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1377648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1377648000000",
"number": "1124452073",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3100 N GLASSFORD HILL RD",
"city": "PRESCOTT VALLEY",
"state": "AZ",
"postal_code": "863142285",
"telephone_number": "928-445-0607"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3100 N GLASSFORD HILL RD",
"city": "PRESCOTT VALLEY",
"state": "AZ",
"postal_code": "863142285",
"telephone_number": "928-445-0607"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "DEREK",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-08-28",
"last_updated": "2013-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AZ",
"license": "S020113",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Prescott Valley, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.