Provider Demographics
NPI:1538760434
Name:CLARK, ALANA ROBERTSON (PHARMD)
Entity type:Individual
Prefix:
First Name:ALANA
Middle Name:ROBERTSON
Last Name:CLARK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:ALANA
Other - Middle Name:CLARK
Other - Last Name:PECKAT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:319 MIRAMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-3202
Mailing Address - Country:US
Mailing Address - Phone:501-231-5782
Mailing Address - Fax:
Practice Address - Street 1:760 MICHAELA DR
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-5361
Practice Address - Country:US
Practice Address - Phone:501-992-1006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD088911835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric