Active NPI
Justin John Clark, PHARMD
- Pharmacist
- Phoenix, AZ
National Provider Identifier
1851622666
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- S017466
- Practice address
- 3945 E Southern Ave
Phoenix, AZ 85040-3961 - Phone
- (602) 426-0501
- Fax
- (602) 426-0567
- NPI assigned
- Jan 18, 2010
- Sex
- Male
- 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 | S017466 | AZ | Primary |
Addresses
Primary practice location
3945 E Southern Ave
Phoenix, AZ 85040-3961
Mailing address
3945 E Southern Ave
Phoenix, AZ 85040-3961
Phone (602) 426-0501
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 |
|---|---|---|---|
| S017466 | AZ | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1263772800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1263772800000",
"number": "1851622666",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3945 E SOUTHERN AVE",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850403961",
"telephone_number": "602-426-0501",
"fax_number": "602-426-0567"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3945 E SOUTHERN AVE",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850403961",
"telephone_number": "602-426-0501",
"fax_number": "602-426-0567"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "JUSTIN",
"middle_name": "JOHN",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-01-18",
"last_updated": "2010-01-18",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AZ",
"license": "S017466",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.