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Organization
MR PRESCRIPTION OF KETTERING INC
Active
Organization
MR PRESCRIPTION OF KETTERING INC
Active
Other names
CLARKS MR PRESCRIPTION
Organization subpart
No
Provider details
NPI number
Authorized official
TIM CLARK (PRESIDENT)
(937) 428-7970
Entity
Organization
Contact information
Practice address
3081 FAR HILLS AVE, KETTERING, OH 45429-2509
(937) 297-0596
(937) 297-0598
Mailing address
7044 SOLUTION CTR, CHICAGO, IL 60677-0001
(937) 428-7970
(937) 428-7978
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
021070350
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2088762
—
OH
01
—
3665330
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
09/21/2006
Last updated
08/29/2011
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