# CLARKDALE PHARMACY AND GIFTS LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Clarkdale Pharmacy and Gifts
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831580778
- **Authorized official:** DANIEL JOHNSON (OWNER)
- **Authorized official phone:** (601) 938-5323

## Contact information

- **Practice address:** 6935C HWY 145, MERIDIAN, MS 39301
- **Practice address phone:** (601) 553-0668
- **Practice address fax:** (601) 553-3048
- **Mailing address:** 6125 ZERO RD, MERIDIAN, MS 39301-8655
- **Mailing address phone:** (601) 553-0668
- **Mailing address fax:** (601) 553-3048

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 14215/1.1 | MS | Yes |

## Other

- **Enumeration date:** 02/13/2015
- **Last updated:** 07/06/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00873551 | — | MS |
| 01 | — | 2150263 | PK | — |