CLARK'S RX FARMINGTON, LLC (CLARK'S RX) - NPI NUMBER 1053659045

Summary

Provider Name: CLARK'S RX FARMINGTON, LLC (CLARK'S RX)

NPI Number: 1053659045

Clasification: Pharmacy (333600000X)

Address:
18 W KARSCH BLVD
FARMINGTON, MO
ZIP 63640

Phone Number: (573) 454-2650



Detailed Information

CLARK'S RX FARMINGTON, LLC is a pharmacy in Farmington, MO. The provider is a facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located. The assigned NPI number for this provider is 1053659045 and is registered as an organization entity type.
The provider Is Doing Business As Clark's Rx.

The provider's business address is:

18 W KARSCH BLVD
FARMINGTON, MO
ZIP 63640-411
Phone: (573) 454-2650
Fax: (573) 454-2651

The provider's authorized official is Timothy Richard Clark .
The authorized official title is Owner/president and has the following contact phone number (937) 428-7970.

The enumeration date for this NPI number is 1/25/2013 and was last updated on 1/25/2013.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 333600000X Pharmacy Yes

NPI Record

No. Field Name Field Value
1 NPI 1053659045
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name CLARK'S RX FARMINGTON, LLC
5 Provider Other Organization Name CLARK'S RX
6 Provider Other Organization Name Type Code 3
7 Provider First Line Business Practice Location Address 18 W KARSCH BLVD
8 Provider Business Practice Location Address City Name FARMINGTON
9 Provider Business Practice Location Address State Name MO
10 Provider Business Practice Location Address Postal Code 636401411
11 Provider Business Practice Location Address Country Code If outside U S US
12 Provider Business Practice Location Address Telephone Number 5734542650
13 Provider Business Practice Location Address Fax Number 5734542651
14 Provider Enumeration Date 1/25/2013
15 Last Update Date 1/25/2013
16 Authorized Official Last Name CLARK
17 Authorized Official First Name TIMOTHY
18 Authorized Official Middle Name RICHARD
19 Authorized Official Title or Position OWNER/PRESIDENT
20 Authorized Official Telephone Number 9374287970
21 Healthcare Provider Taxonomy Code 1 333600000X
22 Healthcare Provider Primary Taxonomy Switch 1 Y
23 Is Organization Subpart N
24 Authorized Official Name Prefix Text MR.
25 Authorized Official Credential Text RPH

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This page was last updated on: 8/12/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.