Active NPI
Charlotte Jean Clark, PHARMD
- Pharmacist
- Macomb, IL
National Provider Identifier
1699374306
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 051.287844
- Practice address
- 1600 E Jackson St
Macomb, IL 61455-2530 - Phone
- (309) 833-3750
- Fax
- (309) 836-8407
- NPI assigned
- Oct 22, 2020
- 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 | 051.287844 | IL | Primary |
Addresses
Primary practice location
1600 E Jackson St
Macomb, IL 61455-2530
Mailing address
210 W Jefferson St
Macomb, IL 61455-2131
Phone (309) 313-2834
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 |
|---|---|---|---|
| 051.287844 | IL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1603324800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1603324800000",
"number": "1699374306",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "210 W JEFFERSON ST",
"city": "MACOMB",
"state": "IL",
"postal_code": "614552131",
"telephone_number": "309-313-2834"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1600 E JACKSON ST",
"city": "MACOMB",
"state": "IL",
"postal_code": "614552530",
"telephone_number": "309-833-3750",
"fax_number": "309-836-8407"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "CHARLOTTE",
"middle_name": "JEAN",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-10-22",
"last_updated": "2020-10-22",
"certification_date": "2020-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051.287844",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Macomb, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.