Clarkson Drug Store, Inc.
Organization Active NPI Pharmacy · Clarkson, KY
NPI 1174615124 · NPPES record last updated Jan 21, 2009
Key facts
- NPI
- 1174615124
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- License
- P00450 (KY)
- Legal business name
- CLARKSON DRUG STORE, INC.
- Practice address
- 201 Millerstown St.
Clarkson, KY 42726-0146 - Phone
- (270) 242-3811
- Fax
- (270) 242-4171
- NPI assigned
- Sep 28, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. James William Marshall, RPH
- Title
- President
- Phone
- (270) 242-3811
Practitioners 1
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Clarkson Drug Store |
Nebulizer Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Ostomy Supplies | Does not accept assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930024992 | KY | DME Supplier - Pharmacy | 1254458847 | Practice locations: Clarkson, KY |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | P00450 | KY | |
| Pharmacy | 333600000X | P00450 | KY | Yes |
Addresses
Primary practice location
201 Millerstown St.
Clarkson, KY 42726-0146
Mailing address
PO Box 146
Clarkson, KY 42726-0146
Phone (270) 242-3811
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000070017 | Other | KY | ANTHEM BC & BS |
| 1802811 | Other | NABP | |
| 54002209 | Medicaid | KY | |
| 90020439 | Medicaid | KY |
Other names
- Clarkson Drug Store
Other providers in Clarkson, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 21, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.