Active NPI
Wade Clark, PHARM.D.
- Pharmacist
- San Rafael, CA
National Provider Identifier
1285849976
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RPH59400
- Practice address
- 99 Monticello Rd
San Rafael, CA 94903 - Phone
- (415) 444-2000
- NPI assigned
- May 14, 2007
- 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 | RPH59400 | CA | Primary |
Addresses
Primary practice location
99 Monticello Rd
San Rafael, CA 94903
Mailing address
2900 Saint Paul Dr Apt 223
Santa Rosa, CA 95405-8527
Phone (530) 249-3354
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 |
|---|---|---|---|
| RPH59400 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179100800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1285849976",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2900 SAINT PAUL DR APT 223",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954058527",
"telephone_number": "530-249-3354"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "99 MONTICELLO RD",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "94903",
"telephone_number": "415-444-2000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "WADE",
"credential": "PHARM.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "RPH59400",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Rafael, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.