Organization
CIP NORTHSIDE LLC
Active
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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