John Joseph Clark, RPH
Individual provider Active NPI Pharmacist · McCook, NE
NPI 1508948480 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1508948480
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 7653 (NE)
- Practice address
- 205 Norris Ave
McCook, NE 69001-3704 - Phone
- (308) 345-2560
- NPI assigned
- Oct 19, 2006
- 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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7653 | NE | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| McCook Pharmacy & Medical Supply | Pharmacist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 7653 | NE | Yes |
Addresses
Primary practice location
205 Norris Ave
McCook, NE 69001-3704
Mailing address
210 N Cherokee Rd
McCook, NE 69001-2206
Phone (308) 345-4594
Other providers in McCook, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.