Diane Clark, R.PH.

Primary specialty

PharmacistTaxonomy code 183500000X

License

7948 Issued in OR

Practice address

3639 Crater Lake Hwy
Medford, OR 97504-9259

Phone

(541) 734-2482

NPI assigned

Feb 15, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Pharmacist

State licenses

Practice roles

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.

• Costco Wholesale Corporation

  dba Costco Pharmacy #1709

  • Community/Retail Pharmacy
  • Las Vegas, NV
  • NPI 1255124269
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1329264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452211200000",
    "number": "1558634980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3639 CRATER LAKE HWY",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975049259",
            "telephone_number": "541-734-2482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3639 CRATER LAKE HWY",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975049259",
            "telephone_number": "541-734-2482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "DIANE",
        "credential": "R.PH.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-02-15",
        "last_updated": "2016-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "OR",
            "license": "7948",
            "primary": true
        },
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "OR",
            "license": "7948",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacqueline Rose Clair-Horn, O.D.
• Leslie Elizabeth Claridge Town
• Clarity Behavioral Medicine LLC
• Bryan Bret Clark
• Carolyn Clark, QMHA, PSS, CRM, CGAC
• Kim Clark, CADCI, A.A.
• Madeline Dorothy Clark
• Tiffany Dawn Clark, LMT
• Tracey Clark
• Joseph Capt Clarke, M.D.

• Pharmacist in Medford, OR
• Providers in Medford, OR by specialty
• Pharmacist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.