Active NPI
Ronald Havis Clark, R.PH.
- Pharmacist
- San Angelo, TX
National Provider Identifier
1992090484
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 19993
- Practice address
- 4405 Winterberry LN
San Angelo, TX 76904-4530 - Phone
- (830) 708-8648
- NPI assigned
- Jun 13, 2011
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 19993 | TX | Primary |
| Pharmacist | 183500000X | 0202011257 | VA |
Addresses
Primary practice location
4405 Winterberry LN
San Angelo, TX 76904-4530
Mailing address
2625 Southland Blvd Apt 19
San Angelo, TX 76904-7549
Phone (830) 708-8648
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0202011257 | VA | MD | Pharmacist |
| 19993 | TX | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1307923200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1316563200000",
"number": "1992090484",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2625 SOUTHLAND BLVD APT 19",
"city": "SAN ANGELO",
"state": "TX",
"postal_code": "769047549",
"telephone_number": "830-708-8648"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4405 WINTERBERRY LN",
"city": "SAN ANGELO",
"state": "TX",
"postal_code": "769044530",
"telephone_number": "830-708-8648"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "RONALD",
"middle_name": "HAVIS",
"credential": "R.PH.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-06-13",
"last_updated": "2011-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "19993",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "VA",
"license": "0202011257",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Angelo, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.