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
—
—
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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