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Contact Information

KENNETH R CLARK
4211 HOSPITAL ST STE 104
PASCAGOULA, MS39581-5310
 Phone: 228-762-1940
 Fax: 228-762-7786
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pharmacist

183500000X
Indicates primary specialty

NPI Profile & details for KENNETH R CLARK · (Male)

NPI Number 1821119959
Status Active
Credentials
Entity Individual
Enumeration date 04/03/2007
Last updated 11/15/2017 - About 9 years ago
Sole proprietor 1 Yes
Identifiers
  • MS License # E-06773
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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