Active NPI
Michael Raymond Clark
- Pharmacist
- Twain Harte, CA
National Provider Identifier
1972006005
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 37360
- Practice address
- 22629 Twain Harte Dr Ste D
Twain Harte, CA 95383-9405 - Phone
- (209) 586-3225
- NPI assigned
- Mar 15, 2018
- Sex
- Male
- Sole proprietor
- Yes
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 | 37360 | CA | Primary |
Addresses
Primary practice location
22629 Twain Harte Dr Ste D
Twain Harte, CA 95383-9405
Mailing address
22118 N Tuolumne Rd
Twain Harte, CA 95383-9605
Phone (209) 352-1411
Other practice location 1
2037 Hwy 4 Ste F
Arnold, CA 95223-9420
Phone (209) 795-1155
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 37360 | CA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Meadowmont Pharmacy Inc | Past | Accepting new patients | |
| Meadowmont Pharmacy Inc | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Community/Retail Pharmacy
- San Andreas, CA
- NPI 1184265175
-
- Community/Retail Pharmacy
- Arnold, CA
- NPI 1396813291
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1521072000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1709078400000",
"number": "1972006005",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22118 N TUOLUMNE RD",
"city": "TWAIN HARTE",
"state": "CA",
"postal_code": "953839605",
"telephone_number": "209-352-1411"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22629 TWAIN HARTE DR STE D",
"city": "TWAIN HARTE",
"state": "CA",
"postal_code": "953839405",
"telephone_number": "209-586-3225"
}
],
"practiceLocations": [
{
"address_1": "2037 Hwy 4 Ste F",
"address_purpose": "LOCATION",
"city": "Arnold",
"state": "CA",
"postal_code": "952239420",
"country_code": "US",
"telephone_number": "209-795-1155",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CLARK",
"first_name": "MICHAEL",
"middle_name": "RAYMOND",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-03-15",
"last_updated": "2024-02-28",
"certification_date": "2024-02-28",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "37360",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Twain Harte, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.