Organization
CLARK PHARMACY LLC
Active
Organization
CLARK PHARMACY LLC
Active
Parent organization
LIFECHEK, INC
Other names
LIFECHEK DRUG #7
Organization subpart
Yes
Provider details
NPI number
Legal business name
LIFECHEK, INC
Authorized official
BRUCE GINGRICH (OWNER/PRESIDENT)
(281) 232-3940
Entity
Organization
Contact information
Practice address
502 W MONTGOMERY ST, WILLIS, TX 77378-8827
(936) 856-4594
(936) 856-3512
Mailing address
1316 7TH ST, ROSENBERG, TX 77471-3531
(281) 232-3940
(832) 595-1203
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
24189
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
140591
—
TX
01
—
4510687
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
08/20/2006
Last updated
03/30/2011
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