Organization
CLARK PHARMACY INC
Active
Other names
CLARK PHARMACY INC
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES COAST RPH CGP (OWNER)
(620) 855-2242
Entity
Organization
Contact information
Practice address
101 S MAIN ST, CIMARRON, KS 67835-9998
(620) 855-2242
(620) 855-3616
Mailing address
PO BOX 207, CIMARRON, KS 67835
(620) 855-2242
(620) 855-3616
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
209276
KS
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2030734
PK
—
Enumeration date
01/03/2007
Last updated
12/04/2013
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