Clark RX LLC
Organization Active NPI Community/Retail Pharmacy · Middletown, OH
NPI 1699047423 · NPPES record last updated Apr 25, 2016
Key facts
- NPI
- 1699047423
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 022201700 (OH)
- Legal business name
- CLARK RX LLC
- 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
- Organization subpart
- No
Authorized official
- Name
- Timothy Clark
- Title
- President
- Phone
- (937) 428-7970
Other NPIs on the same Medicare enrollment 7
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
Locations
710 S Breiel Blvd
Ste B
Middletown, OH 45044
Phone (513) 261-6053
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 022201700 | OH | Yes |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2133770 | Other | PK |
Other names
- CLARK'S RX PHARMACY
Other providers in Middletown, OH
- Patricia A Ciambro
- City of Middletown
- City of Refuge Dba One Way Farm
- Melanie A Clapp
- Clark Audiology LLC
- Ashley Clark
- John Greer Clark
- Margie Ann Clark
- Suzanne Clark
- Jami Clarke
All providers in Middletown, OH · Community/Retail Pharmacy in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 25, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.