Clark County Pharmacy Inc
Organization Active NPI Community/Retail Pharmacy · Kahoka, MO
NPI 1811022049 · NPPES record last updated Oct 14, 2021
Key facts
- NPI
- 1811022049
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 004723 (MO)
- Legal business name
- CLARK COUNTY PHARMACY INC
- Practice address
- 250 S Johnson St
Kahoka, MO 63445-1635 - Phone
- (660) 727-2214
- Fax
- (660) 727-2764
- NPI assigned
- Feb 21, 2007
- Organization subpart
- No
Authorized official
- Name
- Anthony McKee
- Title
- Owner Pharmacist
- Phone
- (660) 727-2214
Corporate family (same tax ID) 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930078886 | MO | DME Supplier - Pharmacy |
7517088768 | Practice locations: Kahoka, MO |
| O20211207000349 | MO | Part B Supplier - Pharmacy | 7517088768 | Practice locations: Kahoka, MO |
National Provider Directory
- Tax ID family
- Clark County Pharmacy Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 004723 | MO | Yes |
| Compounding Pharmacy | 3336C0004X |
Addresses
Primary practice location
250 S Johnson St
Kahoka, MO 63445-1635
Mailing address
250 S Johnson St
Kahoka, MO 63445-1635
Phone (660) 727-2214
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2047958 | Other | PK | |
| 600119309 | Medicaid | MO | |
| 620119305 | Medicaid | MO |
Other providers in Kahoka, MO
- Clark County Nursing Service & Home Health Agency
- Clark County Nursing Service & Home Health Agency
- Clark County Nursing Service & Home Health Agency
- Clark County Pharmacy Inc
- Clark County Pharmacy Inc
- Clark County R-I School District
- Brigitte Renee Cormier
- Crenshaw Family Practice Clinic, PC
- Neville Quinby Crenshaw
- Nicole Davolt
All providers in Kahoka, MO · Community/Retail Pharmacy in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 14, 2021. 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.