Michael E Clark, PHARMD
Individual provider Active NPI Pharmacist · Pacifica, CA
NPI 1780905505 · NPPES record last updated Jun 16, 2010
Key facts
- NPI
- 1780905505
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 28890 (CA)
- Practice address
- 200 Fairmont Shopping Ctr
Pacifica, CA 94044-1240 - Phone
- (650) 355-5810
- Fax
- (650) 355-5882
- NPI assigned
- Jun 16, 2010
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28890 | CA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Thrifty Payless Inc | Past | Accepting new patients | |
| Thrifty Payless Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 28890 | CA | Yes |
Addresses
Primary practice location
200 Fairmont Shopping Ctr
Pacifica, CA 94044-1240
Mailing address
57 Hillcrest CT
San Francisco, CA 94127-1607
Phone (415) 239-2850
Other providers in Pacifica, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 16, 2010. 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.