| Doctor Name: | MR. LARRY PARKES CLARK |
| NPI Number: | 1366710600 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | R.PH. |
| License Number: | 03-2-13207 |
| Business Practice Address: | 34099 Melinz Pkwy Unit G Eastlake, OH - 440954041 |
| Business Phone Number: | 4409530604 |
| Business Fax Number: | |
| Mailing Address: | 34099 Melinz Pkwy, Unit G EASTLAKE |
| State: | OH |
| Postal Code: | 440954041 |
| Phone Number: | 4409530604 |
| Fax Number: | |
| NPI Enumeration Date: | 12/01/2011 |
| NPI Last Update Date: | 12/01/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1835G0303X |
| License Number: | 03-2-13207 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Pharmacy Service Providers |
| Taxonomy Classification: | Pharmacist |
| Taxonomy Specialization: | Geriatric |
| Taxonomy Definition: | A pharmacist who is certified in geriatric pharmacy practice is designated as a |