Organization
CLARENDON OUTPOST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELMONETTE E BIVENS (PHARMACIST IN CHARGE)
(806) 874-5202
Entity
Organization
Contact information
Practice address
619 W 2ND ST, CLARENDON, TX 79226
(806) 874-5202
(806) 874-5204
Mailing address
PO BOX 927, CLARENDON, TX 79226-0927
(806) 874-5202
(806) 874-5204
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
—
—
3336L0003X
Long Term Care Pharmacy
Primary
16767
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010761701
—
TX
05
—
014359601
—
TX
05
—
1104530001
—
TX
05
—
144483
—
TX
Enumeration date
09/08/2017
Last updated
06/16/2021
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