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General NPI Number Information
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NPI Number | 1891381265
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Entity Type | Organization
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Legal Business Name | CIP NORTHSIDE LLC
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Dates
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Enumeration Date | 12/18/2020
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Last Update Date | 12/18/2020
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Provider Practice Location Address
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Address Line | 3802 CATCLAW DR STE 2
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City | ABILENE
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State | TX
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Zip | 79606-8253
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Country | US
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Telephone | 806-451-4799
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Fax | 325-305-0565
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Provider Business Mailing Address
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Address Line | 1113 MURFREESBORO RD STE 106-410
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City | FRANKLIN
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State | TN
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Zip | 37064-1306
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Country | US
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Telephone | 806-451-4799
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Fax | 325-305-0565
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Authorized Official
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Title or Position | MANAGING OFFICER
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Name | DR. CODY CLARK
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Credential | PHARM.D.
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Telephone | 806-451-4799
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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