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 Field Definition 1
1 NPI 1053659045 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name CLARK'S RX FARMINGTON, LLC The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider Other Organization Name CLARK'S RX Other name by which the organization provider is or has been known.
6 Provider Other Organization Name Type Code 3 Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
7 Provider First Line Business Practice Location Address 18 W KARSCH BLVD The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
8 Provider Business Practice Location Address City Name FARMINGTON The city name in the location address of the provider being identified.
9 Provider Business Practice Location Address State Name MO The State code in the location of the provider being identified.
10 Provider Business Practice Location Address Postal Code 636401411 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
11 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
12 Provider Business Practice Location Address Telephone Number 5734542650 The telephone number associated with the location address of the provider being identified.
13 Provider Business Practice Location Address Fax Number 5734542651 The fax number associated with the location address of the provider being identified.
14 Provider Enumeration Date 1/25/2013 The date the provider was assigned a unique identifier (assigned an NPI).
15 Last Update Date 1/25/2013 The date that a record was last updated or changed.
16 Authorized Official Last Name CLARK The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
17 Authorized Official First Name TIMOTHY The first name of the authorized official.
18 Authorized Official Middle Name RICHARD The middle name of the authorized official.
19 Authorized Official Title or Position OWNER/PRESIDENT The title or position of the authorized official.
20 Authorized Official Telephone Number 9374287970 The 10-position telephone number of the authorized official.
21 Healthcare Provider Taxonomy Code 1 333600000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
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: 3/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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