Patricia Kae Clark, PHARM.D.

Primary specialty

PharmacistTaxonomy code 183500000X

License

PS55975 Issued in FL

Practice address

11264 Beach Blvd
Jacksonville, FL 32246-3802

Phone

(904) 641-5411

NPI assigned

Dec 7, 2020

Last updated

Dec 7, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: patricia.clark@cvshealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Holiday CVS L.L.C.

  dba Cvs Pharmacy #17915

  • Pharmacy
  • Wesley Chapel, FL
  • NPI 1770467466
  NPD (past)

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

{
    "created_epoch": "1607299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607299200000",
    "number": "1780280636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11264 BEACH BLVD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322463802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11264 BEACH BLVD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322463802",
            "telephone_number": "904-641-5411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "PATRICIA",
        "middle_name": "KAE",
        "name_prefix": "Dr.",
        "credential": "PHARM.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-12-07",
        "last_updated": "2020-12-07",
        "certification_date": "2020-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "FL",
            "license": "PS55975",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Patricia.clark@cvshealth.com",
            "affiliation": "N",
            "address_1": "11264 Beach Blvd",
            "city": "Jacksonville",
            "state": "FL",
            "country_code": "US",
            "postal_code": "322463802",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Lerone Evanton Clark, DO
• Lindsey Carleen Clark, MD
• Lorraine Polite Clark, DMD
• Nina Clark
• Noel Clark
• Patricia Lynn Clark, DMD
• Sara E Clark, MD
• Shawn W Clark
• Shawna P Clark, CBHCMS, CMHP, HS-BCP
• Stephen Clark, M.D.

• Pharmacist in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Pharmacist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 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.

Verify at the official NPI Registry.