Clarks RX LLC
Organization Active NPI Community/Retail Pharmacy · Huber Heights, OH
NPI 1184723652 · NPPES record last updated Nov 16, 2021
Key facts
- NPI
- 1184723652
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 021231250 (OH)
- Legal business name
- CLARKS RX LLC
- Practice address
- 7415 Old Troy Pike
Huber Heights, OH 45424-2662 - Phone
- (937) 723-2880
- Fax
- (937) 723-2880
- NPI assigned
- Sep 21, 2006
- Organization subpart
- No
Authorized official
- Name
- Tim Clark
- Title
- President
- Phone
- (937) 723-2880
Other NPIs on the same Medicare enrollment 7
Member of 1
Practitioners 3
-
Robyn Kaye Crow, RPH
-
Amanda Dudics, R.PH.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070904000340 | OH | Part B Supplier - Mass Immunization (Roster Biller Only) | 9335232503 |
11 other NPIs on this enrollment Practice locations: Centerville, OH; Huber Heights, OH |
National Provider Directory
Locations
7415 Troy Pike
Huber Heights, OH 45424
Phone (937) 723-2880
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 021231250 | OH | Yes |
| Compounding Pharmacy | 3336C0004X |
Addresses
Primary practice location
7415 Old Troy Pike
Huber Heights, OH 45424-2662
Mailing address
7415 Old Troy Pike
Huber Heights, OH 45424-2662
Phone (937) 723-2880
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2073191 | Other | PK | |
| 2238859 | Medicaid | OH |
Other names
- The Compounding Lab/Independent RX Pharmacy
Other providers in Huber Heights, OH
- Gail Christian
- Elmira Chukadze
- Jonathan Jeffrey Ciesla
- City of Huber Heights
- Gayle Clark
- Joshua Stephen Clemons
- CML Foods LTD
- Kayla D Coates
- Nicole Cobb
- Sean Colbert
All providers in Huber Heights, OH · Community/Retail Pharmacy in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 16, 2021. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.