# CLARENDON OUTPOST

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205833118
- **Authorized official:** ELMONETTE E BIVENS RPH (PHARMACIST IN CHARGE)
- **Authorized official phone:** (806) 874-5202

## Contact information

- **Practice address:** 619 W 2ND, CLARENDON, TX 79226-0927
- **Practice address phone:** (806) 874-5202
- **Practice address fax:** (806) 874-5204
- **Mailing address:** PO BOX 927, CLARENDON, TX 79226-0927
- **Mailing address phone:** (806) 874-5202
- **Mailing address fax:** (806) 874-5204

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 332BX2000X | Oxygen Equipment & Supplies (DME) | — | NULL | — |
| 333600000X | Pharmacy | 16767 | TX | Yes |

## Other

- **Enumeration date:** 07/07/2005
- **Last updated:** 06/11/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 010761701 | — | TX |
| 05 | — | 014359601 | — | TX |
| 05 | — | 144483 | — | TX |