Active NPI
Carol Morris Clark, PHARM. D
- Pharmacist
- Poplar Bluff, MO
National Provider Identifier
1629080338
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 051-039856
- Practice address
- 1500 N Westwood Blvd
Poplar Bluff, MO 63901-3318 - Phone
- (573) 778-4241
- Fax
- (573) 778-4246
- NPI assigned
- Aug 12, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051-039856 | IL | Primary |
Addresses
Primary practice location
1500 N Westwood Blvd
Poplar Bluff, MO 63901-3318
Mailing address
1913 Windy Hill Drive
Frisco, TX 75034
Phone (972) 704-3860
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
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051-039856 | IL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155340800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1357603200000",
"number": "1629080338",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1913 WINDY HILL DRIVE",
"city": "FRISCO",
"state": "TX",
"postal_code": "75034",
"telephone_number": "972-704-3860"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1500 N WESTWOOD BLVD",
"city": "POPLAR BLUFF",
"state": "MO",
"postal_code": "639013318",
"telephone_number": "573-778-4241",
"fax_number": "573-778-4246"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "CAROL",
"middle_name": "MORRIS",
"name_prefix": "Dr.",
"credential": "PHARM. D",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-08-12",
"last_updated": "2013-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051-039856",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Poplar Bluff, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.