Tia C Clark, RPH

Primary specialty

PharmacistTaxonomy code 183500000X

License

10558 Issued in AZ

Practice address

420 S Sossaman Rd
Mesa, AZ 85208-2001

Phone

(480) 985-3658

Fax

(480) 985-4718

NPI assigned

Jun 9, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Pharmacist

State licenses

Practice roles

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

• Walgreen Co

  • Pharmacy
  • Mesa, AZ
  • NPI 1366458002
  NPD (past)
• Walgreen Co

  • Pharmacy
  • Longview, TX
  • NPI 1629956545
  NPD (past)

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

{
    "created_epoch": "1276041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672012800000",
    "number": "1942520291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 S SOSSAMAN RD",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852082001",
            "telephone_number": "480-325-4777",
            "fax_number": "480-325-4544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 S SOSSAMAN RD",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852082001",
            "telephone_number": "480-985-3658",
            "fax_number": "480-985-4718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "TIA",
        "middle_name": "C",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-09",
        "last_updated": "2022-12-26",
        "certification_date": "2022-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "AZ",
            "license": "S010558",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "AZ",
            "license": "10558",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marion Sharon Clark, COTAL
• Marlene L Clark
• Meredith Helen Clark, LPC
• Romney Clark
• Ronald Earl Clark
• Vargas L Clark, MS. ED
• Class Act Downing, L.L.C.
• Class Act Glencove Mesa, LLC
• Class Act Los Alamos, LLC
• Class Act, Inc.

• Pharmacist in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Pharmacist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2022; 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.