Active NPI
Timothy Allen Clark
- Pharmacist
- East Jordan, MI
National Provider Identifier
1437458692
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302025259
- Practice address
- 250 S Lake St
East Jordan, MI 49727-9376 - Phone
- (231) 536-0901
- Fax
- (231) 536-3284
- NPI assigned
- Mar 26, 2011
- 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 | 5302025259 | MI | Primary |
Addresses
Primary practice location
250 S Lake St
East Jordan, MI 49727-9376
Mailing address
1683 E Gruler Rd
Petoskey, MI 49770-8821
Phone (231) 347-6269
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 |
|---|---|---|---|
| 5302025259 | MI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rite Aid | Pharmacist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pharmacist
- East Jordan, MI
- NPI 1245784685
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1301097600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1301097600000",
"number": "1437458692",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1683 E GRULER RD",
"city": "PETOSKEY",
"state": "MI",
"postal_code": "497708821",
"telephone_number": "231-347-6269"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "250 S LAKE ST",
"city": "EAST JORDAN",
"state": "MI",
"postal_code": "497279376",
"telephone_number": "231-536-0901",
"fax_number": "231-536-3284"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "TIMOTHY",
"middle_name": "ALLEN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-03-26",
"last_updated": "2011-03-26",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302025259",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in East Jordan, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.