Robert Justin Clark, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

E-11912 Issued in MS

Practice address

741 Main St
Caledonia, MS 39740-7609

Phone

(662) 356-4000

Fax

(662) 356-4044

NPI assigned

Nov 17, 2020

Last updated

Nov 17, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Clark Drug Company, LLC

  dba Caledonia Pharmacy

  • Community/Retail Pharmacy
  • Caledonia, MS
  • NPI 1013294461
  NPD Authorized official

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

{
    "created_epoch": "1605571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605571200000",
    "number": "1356944003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 478",
            "city": "CALEDONIA",
            "state": "MS",
            "postal_code": "397400478",
            "telephone_number": "662-356-4000",
            "fax_number": "662-356-4044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "741 MAIN ST",
            "city": "CALEDONIA",
            "state": "MS",
            "postal_code": "397407609",
            "telephone_number": "662-356-4000",
            "fax_number": "662-356-4044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ROBERT",
        "middle_name": "JUSTIN",
        "name_prefix": "Dr.",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-11-17",
        "last_updated": "2020-11-17",
        "certification_date": "2020-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MS",
            "license": "E-11912",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alvin Ray Beezley Jr., D. O.
• Blissful Moments Doula & Birth Services, LLC.
• Caledonia Community Clinic, LLC
• Lee Vester Calvert Jr., FNP-C
• Clark Drug Company, LLC (Caledonia Pharmacy)
• Kathryn Comer
• Kelsey Melane Dement
• Fig Leaf, LLC (Caledonia Community Clinic)
• Misty S Glasgow, OTR
• Golden Triangle Family Eye Care, PLLC (Caledonia Vision Center)

• Pharmacist in Caledonia, MS
• Providers in Caledonia, MS by specialty
• Pharmacist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.