NPIMap

Organization Active NPI

Clark'S Pharmacy, Inc

  • Community/Retail Pharmacy
  • Cedar Rapids, IA
National Provider Identifier
1285732503
Registry record updated Jul 28, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
566 Issued in IA
Legal business name
CLARK'S PHARMACY, INC
Practice address
1946 42ND St NE
Cedar Rapids, IA 52402-3041
Phone
(319) 393-3210
Fax
(319) 393-2747
NPI assigned
Sep 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Craig Leo Clark, R. PH.NPI 1487609111
Title
R.PH. / Owner
Phone
(319) 393-3210

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 566 IA Primary

Addresses

Primary practice location

1946 42ND St NE
Cedar Rapids, IA 52402-3041

Mailing address

1946 42ND St NE
Cedar Rapids, IA 52402-3041
Phone (319) 393-3210

Other identifiers 1

IdentifierTypeStateIssuer
0133439MedicaidIA

Other names 1

  • Clark's Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930065402 IA DME Supplier - Pharmacy 5092759688 Practice locations: Cedar Rapids, IA
O20140730000422 IA Part B Supplier - Mass Immunization (Roster Biller Only) 5092759688 Practice locations: Cedar Rapids, IA

National Provider Directory

National Provider Directory
Tax ID family
Clark'S Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1248739200000",
    "number": "1285732503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1946 42ND ST NE",
            "city": "CEDAR RAPIDS",
            "state": "IA",
            "postal_code": "524023041",
            "telephone_number": "319-393-3210",
            "fax_number": "319-393-2747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1946 42ND ST NE",
            "city": "CEDAR RAPIDS",
            "state": "IA",
            "postal_code": "524023041",
            "telephone_number": "319-393-3210",
            "fax_number": "319-393-2747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARK'S PHARMACY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2009-07-28",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_middle_name": "LEO",
        "authorized_official_title_or_position": "R.PH. / OWNER",
        "authorized_official_telephone_number": "319-393-3210",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "R. PH."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IA",
            "license": "566",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0133439",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clark's Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cedar Rapids, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.