Active NPI
Dennis Ray Clark, R.PH.
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- Grants Pass, OR
National Provider Identifier
1750629267
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- License
- 7947
- Practice address
- 162 NE Beacon Dr
Suite #109
Grants Pass, OR 97526-4260 - Phone
- (541) 474-3784
- NPI assigned
- Jan 18, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 7947 | OR | |
| Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | 7947 | OR | Primary |
Addresses
Primary practice location
162 NE Beacon Dr
Suite #109
Grants Pass, OR 97526-4260
Mailing address
162 NE Beacon Dr
Suite #109
Grants Pass, OR 97526-4260
Phone (541) 474-3784
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7947 | OR | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rxmedlab Pharmacy , LLC | Past | Accepting new patients | |
| Rxmedications Incorporated | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Compounding Pharmacy
- Grants Pass, OR
- NPI 1528306081
-
- Community/Retail Pharmacy
- Grants Pass, OR
- NPI 1487050951
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1358467200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1358467200000",
"number": "1750629267",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "162 NE BEACON DR",
"address_2": "SUITE #109",
"city": "GRANTS PASS",
"state": "OR",
"postal_code": "975264260",
"telephone_number": "541-474-3784"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "162 NE BEACON DR",
"address_2": "SUITE #109",
"city": "GRANTS PASS",
"state": "OR",
"postal_code": "975264260",
"telephone_number": "541-474-3784"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "DENNIS",
"middle_name": "RAY",
"name_prefix": "Mr.",
"credential": "R.PH.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-01-18",
"last_updated": "2013-01-18",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OR",
"license": "7947",
"primary": false
},
{
"code": "1835P0018X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
"state": "OR",
"license": "7947",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grants Pass, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 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.