Organization
CIP NORTHSIDE LLC
Active
Other names
CIP Northside Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CODY CLARK PHARM.D. (MANAGING OFFICER)
(806) 451-4799
Entity
Organization
Contact information
Practice address
3802 CATCLAW DR STE 2, ABILENE, TX 79606-8253
(806) 451-4799
(325) 305-0565
Mailing address
1113 MURFREESBORO RD STE 106-410, FRANKLIN, TN 37064-1306
(806) 451-4799
(325) 305-0565
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
12/18/2020
Last updated
12/18/2020
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