Provider Demographics
NPI:1548544240
Name:CLARK, CHERYL ANN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:ANN
Last Name:CLARK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 VOGEL RD
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63010-6204
Mailing Address - Country:US
Mailing Address - Phone:636-282-7555
Mailing Address - Fax:
Practice Address - Street 1:3900 VOGEL RD
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010-6204
Practice Address - Country:US
Practice Address - Phone:636-282-7555
Practice Address - Fax:314-909-7150
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-29
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO045119183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist