Organization
CIP NORTHSIDE LLC
Active
Other names
Taylor County Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
CODY CLARK PHARMD (MANAGING OFFICER/OWNER/AO)
(806) 773-5958
Entity
Organization
Contact information
Practice address
1640 STATE HIGHWAY 351, ABILENE, TX 79601-4746
(325) 704-4208
(325) 305-0565
Mailing address
3410 98TH ST STE 4-369, LUBBOCK, TX 79423-3847
(806) 451-4799
(325) 305-0565
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
31261
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2167749
PK
—
Enumeration date
01/17/2017
Last updated
04/24/2020
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