Active NPI
Jason Clark, RPH
- Pharmacist
- Spartanburg, SC
National Provider Identifier
1184912883
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 009365
- Practice address
- 3021 Reidville Rd
Spartanburg, SC 29301-5643 - Phone
- (864) 576-9201
- Fax
- (864) 576-6584
- NPI assigned
- Jul 14, 2011
- Last updated
- Jun 19, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 009365 | SC | Primary |
Addresses
Primary practice location
3021 Reidville Rd
Spartanburg, SC 29301-5643
Mailing address
552 Verdae Dr
Spartanburg, SC 29301-5384
Phone (864) 237-2099
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 009365 | Other | SC | PHARMACIST |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 009365 | SC | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1310601600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1340064000000",
"number": "1184912883",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "552 VERDAE DR",
"city": "SPARTANBURG",
"state": "SC",
"postal_code": "293015384",
"telephone_number": "864-237-2099"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3021 REIDVILLE RD",
"city": "SPARTANBURG",
"state": "SC",
"postal_code": "293015643",
"telephone_number": "864-576-9201",
"fax_number": "864-576-6584"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "JASON",
"name_prefix": "Mr.",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-07-14",
"last_updated": "2012-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "SC",
"license": "009365",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHARMACIST",
"identifier": "009365",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Spartanburg, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.