Organization
CLARKDALE PHARMACY AND GIFTS LLC
Active
Other names
Clarkdale Pharmacy and Gifts
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL JOHNSON (OWNER)
(601) 938-5323
Entity
Organization
Contact information
Practice address
6935C HWY 145, MERIDIAN, MS 39301
(601) 553-0668
(601) 553-3048
Mailing address
6125 ZERO RD, MERIDIAN, MS 39301-8655
(601) 553-0668
(601) 553-3048
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
14215/1.1
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00873551
—
MS
01
—
2150263
PK
—
Enumeration date
02/13/2015
Last updated
07/06/2016
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