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General NPI Number Information
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NPI Number | 1518185685
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Entity Type | Organization
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Legal Business Name | CLARKSTONRX LLC
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 04/15/2019
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Provider Practice Location Address
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Address Line | 5838 S MAIN ST STE B
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City | CLARKSTON
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State | MI
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Zip | 48346-5201
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Country | US
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Telephone | 248-625-9490
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Fax | 248-625-9207
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Provider Business Mailing Address
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Address Line | 5838 S MAIN ST
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City | CLARKSTON
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State | MI
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Zip | 48346-5201
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Country | US
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Telephone | 248-625-9490
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Fax | 248-625-9207
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Authorized Official
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Title or Position | MEMBER
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Name | ANDREW NELSON
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Credential |
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Telephone | 248-625-9490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 5301007964
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License Number State | MI
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