Provider Demographics
NPI:1922833151
Name:CLARK, ASHLYN RENAE (PHARMD)
Entity type:Individual
Prefix:
First Name:ASHLYN
Middle Name:RENAE
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 1:1533 TERRYTOWN MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:WYALUSING
Mailing Address - State:PA
Mailing Address - Zip Code:18853-8379
Mailing Address - Country:US
Mailing Address - Phone:570-721-5275
Mailing Address - Fax:
Practice Address - Street 1:77 REUTER BLVD
Practice Address - Street 2:
Practice Address - City:TOWANDA
Practice Address - State:PA
Practice Address - Zip Code:18848-2154
Practice Address - Country:US
Practice Address - Phone:570-265-7882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP458858183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist