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General NPI Number Information
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NPI Number | 1427023480
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Entity Type | Organization
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Legal Business Name | C & R CLINIC PHARMACY INC. OF ELKHART
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Dates
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Enumeration Date | 02/22/2006
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Last Update Date | 03/05/2008
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Provider Practice Location Address
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Address Line | 411 SUNSET DRIVE
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City | ELKHART
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State | KS
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Zip | 67950-0962
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Country | US
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Telephone | 620-697-2131
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Fax | 620-697-4643
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Provider Business Mailing Address
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Address Line | PO BOX 962
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City | ELKHART
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State | KS
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Zip | 67950-0962
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Country | US
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Telephone | 620-697-2131
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Fax | 620-697-4643
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Authorized Official
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Title or Position | OWNER/PHARMACIST IN CHARGE
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Name | MR. JERRY L SCOTT
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Credential | RPH
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Telephone | 620-697-2131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 6590
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License Number State | KS
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