Clarkdale Pharmacy and Gifts LLC

Key facts

NPI

1831580778

Entity type

Organization (NPI type 2)

Primary specialty

Community/Retail Pharmacy 3336C0003X

License

14215/1.1 (MS)

Legal business name

CLARKDALE PHARMACY AND GIFTS LLC

Practice address

6935C Hwy 145
Meridian, MS 39301

Phone

(601) 553-0668

Fax

(601) 553-3048

NPI assigned

Feb 13, 2015

Organization subpart

No

Authorized official

Name

Daniel Johnson

Title

Owner

Phone

(601) 938-5323

National Provider Directory

Locations

Specialties & licenses

Addresses

Other identifiers

Other names

• Clarkdale Pharmacy and Gifts Doing business as

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 6, 2016.

{
    "created_epoch": "1423785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467763200000",
    "number": "1831580778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6125 ZERO RD",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393018655",
            "telephone_number": "601-553-0668",
            "fax_number": "601-553-3048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6935C HWY 145",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "39301",
            "telephone_number": "601-553-0668",
            "fax_number": "601-553-3048"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARKDALE PHARMACY AND GIFTS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-13",
        "last_updated": "2016-07-06",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-938-5323"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MS",
            "license": "14215/1.1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2150263",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00873551",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clarkdale Pharmacy and Gifts",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Meridian, MS

• James Eugene Clark, D.D.S.
• Kimberly Deyonne Clark, CMHT
• Robert E Clark, M.D.
• Ronald H Clark, DC
• Sandra Denice Clark, ED.S
• Demetrius Clay, LPC, ED.S, MS
• Olivia Grace Clay, ATC
• Comanechi Clayton, PMHNP-BC
• Danielle Clayton, PHARMD
• Takymmea Clayton, PHD, LP

All providers in Meridian, MS · Community/Retail Pharmacy in Mississippi