NPIMap

Individual provider Active NPI

Benjamin Addril Clark, RPH

  • Pharmacist
  • Reidsville, GA
National Provider Identifier
1548750110
Registry record updated May 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
RPH016066 Issued in GA
Practice address
SE Regional Pharmacy Attn: Ben Clark
300 First Avenue South
Reidsville, GA 30453
Phone
(912) 557-7960
Fax
(912) 557-7975
NPI assigned
May 18, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 18, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X RPH016066 GA Primary

Addresses

Primary practice location

SE Regional Pharmacy Attn: Ben Clark
300 First Avenue South
Reidsville, GA 30453

Mailing address

SE Regional Pharmacy Attn: Ben Clark
300 First Avenue South
Reidsville, GA 30453

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

LicenseStateTypeSpecialty
RPH016066GAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Georgia State Prison Regional Pharmacy Past Accepting new patients

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1526601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526601600000",
    "number": "1548750110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "SE REGIONAL PHARMACY ATTN: BEN CLARK",
            "address_2": "300 FIRST AVENUE SOUTH",
            "city": "REIDSVILLE",
            "state": "GA",
            "postal_code": "30453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "SE REGIONAL PHARMACY ATTN: BEN CLARK",
            "address_2": "300 FIRST AVENUE SOUTH",
            "city": "REIDSVILLE",
            "state": "GA",
            "postal_code": "30453",
            "telephone_number": "912-557-7960",
            "fax_number": "912-557-7975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "BENJAMIN",
        "middle_name": "ADDRIL",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-18",
        "last_updated": "2018-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "GA",
            "license": "RPH016066",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Reidsville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2018; 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.