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General NPI Number Information
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NPI Number | 1184723652
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Entity Type | Organization
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Legal Business Name | CLARKS RX LLC
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 11/16/2021
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Provider Practice Location Address
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Address Line | 7415 OLD TROY PIKE
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City | HUBER HEIGHTS
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State | OH
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Zip | 45424-2662
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Country | US
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Telephone | 937-723-2880
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Fax | 937-723-2880
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Provider Business Mailing Address
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Address Line | 7415 OLD TROY PIKE
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City | HUBER HEIGHTS
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State | OH
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Zip | 45424-2662
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Country | US
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Telephone | 937-723-2880
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Fax | 937-428-7978
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Authorized Official
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Title or Position | PRESIDENT
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Name | TIM CLARK
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Credential |
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Telephone | 937-723-2880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 021231250
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License Number State | OH
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