NPIMap

Organization Active NPI

Clarks RX LLC

Doing business as Clark's Rx Pharmacy

  • Community/Retail Pharmacy
  • Cincinnati, OH
National Provider Identifier
1710257902
Registry record updated Dec 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
022177150 Issued in OH
Legal business name
CLARKS RX LLC
Doing business as
Clark's Rx Pharmacy
Practice address
9749 Montgomery Rd
Cincinnati, OH 45242-7207
Phone
(513) 618-0185
Fax
(513) 618-0186
NPI assigned
Jan 5, 2012
Last updated
Dec 13, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2012

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 022177150 OH Primary

Addresses

Primary practice location

9749 Montgomery Rd
Cincinnati, OH 45242-7207

Mailing address

7060 Solutions Center Dr
Chicago, IL 60677-0001
Phone (937) 428-7970

Other identifiers 1

IdentifierTypeStateIssuer
3680142OtherNCPDP PROVIDER IDENTIFICATION NUMBER

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

9749 Montgomery Rd
Montgomery, OH 45242
Phone (513) 618-0185

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1325721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355356800000",
    "number": "1710257902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7060 SOLUTIONS CENTER DR",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606770001",
            "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": "9749 MONTGOMERY RD",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452427207",
            "telephone_number": "513-618-0185",
            "fax_number": "513-618-0186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARKS RX LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-05",
        "last_updated": "2012-12-13",
        "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": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OH",
            "license": "022177150",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "3680142",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clark's Rx Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cincinnati, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2012; 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.