Provider Demographics
NPI:1437263985
Name:CLARK, DANNY LYNN (RPH)
Entity type:Individual
Prefix:MR
First Name:DANNY
Middle Name:LYNN
Last Name:CLARK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 NORTH MAIN
Mailing Address - Street 2:BOX 277
Mailing Address - City:LOCKNEY
Mailing Address - State:TX
Mailing Address - Zip Code:79241
Mailing Address - Country:US
Mailing Address - Phone:806-652-3353
Mailing Address - Fax:806-652-2118
Practice Address - Street 1:309 NORTH MAIN
Practice Address - Street 2:
Practice Address - City:LOCKNEY
Practice Address - State:TX
Practice Address - Zip Code:79241
Practice Address - Country:US
Practice Address - Phone:806-652-3353
Practice Address - Fax:806-652-2118
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21756183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143439Medicaid
TX4578348OtherNABP NUMBER
TX4804480001Medicare NSC