Clark Kebodeaux, PHARM.D.

Primary specialty

PharmacistTaxonomy code 183500000X

License

2011021859 Issued in MO

Practice address

4218 Lindell Blvd
Saint Louis, MO 63108-2916

Phone

(314) 534-3829

NPI assigned

Jul 19, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

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

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

{
    "created_epoch": "1279497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1312934400000",
    "number": "1669785697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4588 PARKVIEW PL",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101029",
            "telephone_number": "314-446-8508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4218 LINDELL BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631082916",
            "telephone_number": "314-534-3829"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEBODEAUX",
        "first_name": "CLARK",
        "name_prefix": "Dr.",
        "credential": "PHARM.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-19",
        "last_updated": "2011-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "KY",
            "license": "015036",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MO",
            "license": "2011021859",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christina Leigh Kearse, MD
• Richard J Keating, M.D.
• Floreana Andina Naef Kebaish, MD
• Caroline Kebbe, LCSW
• Robert S Kebler, MD
• Loza Kebret, MD
• Sita Kedia, MD MPH
• Lisa Kedro, LMSW
• Rachel C Keech, DO
• Karen S Keefe

• Pharmacist in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Pharmacist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2011; 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.