Organization
CLEAR STREAM LTC, LLC
Active
Other names
Clear Stream LTC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK TAYLOR KLEINBECK RPH (PRESIDENT)
(573) 686-4556
Entity
Organization
Contact information
Practice address
2210 BARRON RD STE B-012, POPLAR BLUFF, MO 63901-1908
(573) 686-4556
(573) 686-4529
Mailing address
2210 BARRON RD STE B-012, POPLAR BLUFF, MO 63901-1908
(573) 686-4556
(573) 686-4529
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
2007013239
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2007013239
PHARMACY PERMIT
MO
01
—
K90FQ0Y00
HIN
—
Enumeration date
06/12/2007
Last updated
03/07/2023
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