Provider Demographics
NPI:1538482922
Name:CLARK, CAROLINE ELIZABETH (RPH)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:ELIZABETH
Last Name:CLARK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:CAROLINE
Other - Middle Name:ELIZABETH
Other - Last Name:HANGGI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:107 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14572-1033
Mailing Address - Country:US
Mailing Address - Phone:585-728-2250
Mailing Address - Fax:585-728-2198
Practice Address - Street 1:107 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:NY
Practice Address - Zip Code:14572-1033
Practice Address - Country:US
Practice Address - Phone:585-728-2250
Practice Address - Fax:585-728-2198
Is Sole Proprietor?:No
Enumeration Date:2010-03-12
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047497183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist