NPIMap

Organization Active NPI

Clark RX LLC

Doing business as Clark's RX Pharmacy

  • Community/Retail Pharmacy
  • Middletown, OH
National Provider Identifier
1699047423
Registry record updated Apr 25, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
022201700 Issued in OH
Legal business name
CLARK RX LLC
Doing business as
Clark's RX Pharmacy
Practice address
710 S Breiel Blvd Ste B
Middletown, OH 45044-6202
Phone
(513) 261-6053
Fax
(513) 261-6054
NPI assigned
Feb 9, 2012
Last updated
Apr 25, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2016

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

Authorized official

Name
Timothy Clark
Title
President
Phone
(937) 428-7970

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 022201700 OH Primary

Addresses

Primary practice location

710 S Breiel Blvd Ste B
Middletown, OH 45044-6202

Mailing address

7333 Paragon Rd
Suite 160
Centerville, OH 45459-4155
Phone (937) 428-7970

Other names 1

  • CLARK'S RX PHARMACY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070904000340 OH Part B Supplier - Mass Immunization (Roster Biller Only) 9335232503 11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Centerville, OH; Huber Heights, OH

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

710 S Breiel Blvd
Ste B
Middletown, OH 45044
Phone (513) 261-6053

NPI Registry JSON

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

{
    "created_epoch": "1328745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461542400000",
    "number": "1699047423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7333 PARAGON RD",
            "address_2": "SUITE 160",
            "city": "CENTERVILLE",
            "state": "OH",
            "postal_code": "454594155",
            "telephone_number": "937-428-7970",
            "fax_number": "937-428-7978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 S BREIEL BLVD STE B",
            "city": "MIDDLETOWN",
            "state": "OH",
            "postal_code": "450446202",
            "telephone_number": "513-261-6053",
            "fax_number": "513-261-6054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARK RX LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-09",
        "last_updated": "2016-04-25",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "937-428-7970"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OH",
            "license": "022201700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CLARK'S RX PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Middletown, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.