Active NPI
Lynette M Clark
- Pharmacist
- Fort Bragg, NC
National Provider Identifier
1205401999
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 11953
- Practice address
- 2655 Reilly St BLDG 4-1571
Fort Bragg, NC 28310-8757 - Phone
- (910) 908-8374
- NPI assigned
- May 25, 2021
- Sex
- Female
- 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 | 11953 | NC | Primary |
Addresses
Primary practice location
2655 Reilly St BLDG 4-1571
Fort Bragg, NC 28310-8757
Mailing address
PO Box 4779
Pinehurst, NC 28374-4779
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11953 | NC | MD | Pediatric Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1621900800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1621900800000",
"number": "1205401999",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 4779",
"city": "PINEHURST",
"state": "NC",
"postal_code": "283744779"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2655 REILLY ST BLDG 4-1571",
"city": "FORT BRAGG",
"state": "NC",
"postal_code": "283108757",
"telephone_number": "910-908-8374"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "LYNETTE",
"middle_name": "M",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-05-25",
"last_updated": "2021-05-25",
"certification_date": "2021-05-25",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NC",
"license": "11953",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Bragg, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.