Robert Justin Clark, PHARMD
Individual provider Active NPI Pharmacist · Caledonia, MS
NPI 1356944003 · NPPES record last updated Nov 17, 2020
Key facts
- NPI
- 1356944003
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- E-11912 (MS)
- Practice address
- 741 Main St
Caledonia, MS 39740-7609 - Phone
- (662) 356-4000
- Fax
- (662) 356-4044
- NPI assigned
- Nov 17, 2020
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E-11912 | MS | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Clark Drug Company, LLC | Current |
Accepting new patients |
Locations
741 Main St
Caledonia, MS 39740
Phone (662) 356-4000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | E-11912 | MS | Yes |
Addresses
Primary practice location
741 Main St
Caledonia, MS 39740-7609
Mailing address
PO Box 478
Caledonia, MS 39740-0478
Phone (662) 356-4000
Other providers in Caledonia, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 17, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.