Organization
CLARK PHARMACY INC
Active
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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