Mary E Clark, CPHT
Individual provider Active NPI Pharmacy Technician · Orofino, ID
NPI 1639840911 · NPPES record last updated Sep 25, 2021
Key facts
- NPI
- 1639840911
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacy Technician 183700000X
- License
- 30178781 (ID)
- Practice address
- 1105 Michigan Ave
Orofino, ID 83544-9005 - Phone
- (208) 476-3600
- NPI assigned
- Sep 25, 2021
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30178781 | ID | MD | Pharmacy Technician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy Technician | 183700000X | 30178781 | ID | Yes |
Addresses
Primary practice location
1105 Michigan Ave
Orofino, ID 83544-9005
Mailing address
89 Sunnyside Bench Rd
Lenore, ID 83541-5028
Phone (208) 451-6535
Other providers in Orofino, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 25, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.