DEREK CLARK (NPI# 1124452073) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124452073 |
| Entity Type | Individual |
| Full Name | DEREK CLARK |
| Credential | PHARMD |
| Practice Address |
3100 N Glassford Hill Rd Prescott Valley AZ 86314-2285 |
| Practice Telephone | 9284450607 |
| Mailing Telephone | 9284450607 |
| Enumeration Date | 2013-08-28 |
| Last Update Date | 2013-08-28 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183500000X | Pharmacist | S020113 | AZ | Pharmacy Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083156061 | Derek Clark | Physical Therapist | 6349 Garners Ferry Rd, Columbia, SC 29209 | 2016-11-08 |
| 1487070942 | Derek Clark | Specialist/Technologist | 625 Beaver St, Leetsdale, PA 15056-1200 | 2014-03-07 |
| 1497161590 | Derek Clark | Orthotist | 5111 Juan Tabo Blvd Ne, Ste A, Albuquerque, NM 87111 | 2014-07-09 |
| 1518283589 | Derek William Clark | Psychiatry & Neurology | 500 17th Ave, Seattle, WA 98122-5711 | 2010-04-15 |
| 1902059843 | Derek Dwight Clark | Physical Therapist | 116 Market St, Mannington, WV 26582-1131 | 2008-10-23 |
| Street Address |
3100 N GLASSFORD HILL RD |
| City | PRESCOTT VALLEY |
| State | AZ |
| Zip Code | 86314-2285 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487658431 | Linda Beth Roberts | Physician Assistant | 3100 N Glassford Hill Rd, Prescott Valley, AZ 86314-2285 | 2005-06-08 |
| 1538525183 | Justin Dinh | Pharmacist | 3100 N Glassford Hill Rd, Prescott Valley, AZ 86314-2285 | 2016-01-12 |
| 1497151864 | Payal Patel | Pharmacist | 3100 N Glassford Hill Rd, Prescott Valley, AZ 86314-2285 | 2014-11-13 |
| 1689924748 | Heidi W Henen | Pharmacist | 3100 N Glassford Hill Rd, Prescott Valley, AZ 86314-2285 | 2012-09-17 |
| 1346513322 | Amy S Kille | Pharmacist | 3100 N Glassford Hill Rd, Prescott Valley, AZ 86314-2285 | 2012-02-21 |
| 1124321088 | Anita M Gilbert | Nurse Practitioner | 3100 N Glassford Hill Rd, Prescott Valley, AZ 86314-2285 | 2010-12-15 |
| 1417273582 | Bruce Michael Worrall | Pharmacist | 3100 N Glassford Hill Rd, Prescott Valley, AZ 86314-2285 | 2010-04-14 |
| 1114969797 | Smiths Food & Drug Centers Inc | Durable Medical Equipment & Medical Supplies | 3100 N Glassford Hill Rd, Prescott Valley, AZ 86314-2285 | 2006-06-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992326029 | Sequelcare of Arizona | Community Based Residential Treatment Facility, Mental Illness | 3001 N. Mountain View Rd, Prescott Valley, AZ 86314 | 2020-04-29 |
| 1124666516 | Best Care Behavioral Homes LLC | Community/Behavioral Health | 5385 W Saddleback Drive, Prescott Valley, AZ 86314 | 2019-12-16 |
| 1912541558 | The Stateserv Companies, LLC | Durable Medical Equipment & Medical Supplies | 8926 E. Long Mesa Drive, Prescott Valley, AZ 86314 | 2019-11-06 |
| 1003398983 | Richard Telck | Pharmacist | 7720 E. Highway 69, Prescott Valley, AZ 86314 | 2018-09-06 |
| 1912493065 | Akdhc,llc | Internal Medicine | 7862 E Florentine Rd, Suite 120, Prescott Valley, AZ 86314 | 2018-07-02 |
| 1700377983 | Pronghorn Psychiatry | Clinic/Center | 5940 E. Copper Hill Dr, Suite E, Prescott Valley, AZ 86314 | 2018-05-23 |
| 1689185126 | Thumb Butte Urgent Care | Clinic/Center | 6496 East Highway 69, Prescott Valley, AZ 86314 | 2017-10-23 |
| 1740738046 | Janine Kauffmann | Pharmacist | 7720 East Highway 69, Prescott Valley, AZ 86314 | 2016-09-14 |
| 1528415650 | Nazcare, Inc. | Exclusive Provider Organization | 8200 E. Jacque Dr., Prescott Valley, AZ 86314 | 2016-05-18 |
| 1184087009 | William Beverly | Marriage & Family Therapist | 8603 E. Eastridge Dr., Ste A, Prescott Valley, AZ 86314 | 2016-03-29 |
| Find all providers in zip 86314 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003398983 | Richard Telck | Pharmacist | 7720 E. Highway 69, Prescott Valley, AZ 86314 | 2018-09-06 |
| 1740738046 | Janine Kauffmann | Pharmacist | 7720 East Highway 69, Prescott Valley, AZ 86314 | 2016-09-14 |
| 1497123541 | Bibina Fonjong | Pharmacist | 1151 N Half Hitch Rd, Prescott Valley, AZ 86314-1462 | 2015-09-07 |
| 1346647021 | Christopher Gregory | Pharmacist | 7550 East Highway 69, Prescott Valley, AZ 86314 | 2014-11-25 |
| 1568871044 | Darshan Sojitra | Pharmacist | 7450 E. Highway 69, Prescott Valley, AZ 86314 | 2014-08-08 |
| 1003238486 | Rhonda Freymuth | Pharmacist | 5757 E State Route 69, Prescott Valley, AZ 86314-2801 | 2014-01-20 |
| 1841540291 | Nathan Scott Mcclellan | Pharmacist | 7450 E Highway 69, Prescott Valley, AZ 86314 | 2012-09-13 |
| 1922317015 | Robert D Ferguson | Pharmacist | 7221 E Sienna Springs Ln, Prescott Valley, AZ 86314-1455 | 2010-10-07 |
| 1356663108 | David Haudek | Pharmacist | 7550 E. Highway #69, Prescott Valley, AZ 86314-2214 | 2010-02-22 |
| 1639491772 | Elise R. Banyai | Pharmacist | 7550 E State Route 69, Prescott Valley, AZ 86314-2214 | 2010-02-16 |
| Find all providers in PRESCOTT VALLEY | ||||
| City | PRESCOTT VALLEY |
| Zip Code | 86314 |
Please comment or provide details below to improve the information on DEREK CLARK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.