MEDICARE: CLARKES PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0004X	Compounding Pharmacy
3	3336C0003X	Community/Retail Pharmacy	PH29989	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2159396	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992180996
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLARKES PHARMACY

Provider Business Mailing Address
First Line	:	3989 S JOG RD
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33467-1514
Country	:	US
Telephone Number	:	561-660-6268
Fax Number	:	561-660-6271

Provider Business Practice Location Address
First Line	:	3989 S JOG RD
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33467-1514
Country	:	US
Telephone Number	:	561-660-6268
Fax Number	:	561-660-6271

Authorized Official
Title or Position	:	OWNER
Name	:	HUGH CLARKE
Credential	:	RPH
Telephone Number	:	954-234-6629

Provider Enumeration Date	:	07/21/2015
Last Update Date	:	06/10/2016

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