# CLARK RX LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** CLARK'S RX PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699047423
- **Authorized official:** TIMOTHY CLARK (PRESIDENT)
- **Authorized official phone:** (937) 428-7970

## Contact information

- **Practice address:** 710 S BREIEL BLVD STE B, MIDDLETOWN, OH 45044-6202
- **Practice address phone:** (513) 261-6053
- **Practice address fax:** (513) 261-6054
- **Mailing address:** 7333 PARAGON RD, SUITE 160, CENTERVILLE, OH 45459-4155
- **Mailing address phone:** (937) 428-7970
- **Mailing address fax:** (937) 428-7978

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 022201700 | OH | Yes |

## Other

- **Enumeration date:** 02/09/2012
- **Last updated:** 04/25/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2133770 | PK | — |