Kenneth R Clark

Primary specialty

PharmacistTaxonomy code 183500000X

License

E-06773 Issued in MS

Practice address

4211 Hospital St Ste 104
Pascagoula, MS 39581-5310

Phone

(228) 762-1940

Fax

(228) 762-7786

NPI assigned

Apr 3, 2007

Sex

Male

Sole proprietor

Yes

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.

• Plaza Pharmacy Inc

  • Community/Retail Pharmacy
  • Pascagoula, MS
  • NPI 1295894293
  NPD Authorized official
• Premier Medical Equipment & Supplies, Inc

  • Durable Medical Equipment & Medical Supplies
  • Pascagoula, MS
  • NPI 1669427076
  NPD Authorized official
• Complete Health Urgicare, Inc

  • Urgent Care Clinic/Center
  • Pascagoula, MS
  • NPI 1093139040
  NPD

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 15, 2017.

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1510704000000",
    "number": "1821119959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2415 BEACH BLVD",
            "city": "PASCAGOULA",
            "state": "MS",
            "postal_code": "395671422",
            "telephone_number": "228-623-1392",
            "fax_number": "228-762-7786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4211 HOSPITAL ST STE 104",
            "city": "PASCAGOULA",
            "state": "MS",
            "postal_code": "395815310",
            "telephone_number": "228-762-1940",
            "fax_number": "228-762-7786"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KENNETH",
        "middle_name": "R",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-03",
        "last_updated": "2017-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MS",
            "license": "E-06773",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Caver-Rains Inc
• Miesha Chandler
• Solly Silwan Chedid, M.D.
• Childrens Clinic of Pascagoula PLLC
• Lisa Christopher, RD
• William Clark
• James Clarkson, M.D.
• Jamesha Clayton
• CLC of Pascagoula, LLC
• Chelsea Jones Clements, PHARMD

• All providers in Pascagoula, MS
• Pharmacist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.