Provider Demographics
NPI:1003942087
Name:CLARK DRUGS INC
Entity Type:Organization
Organization Name:CLARK DRUGS INC
Other - Org Name:CLARK DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FLENER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:270-524-3669
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:MUNFORDVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42765
Mailing Address - Country:US
Mailing Address - Phone:270-524-3669
Mailing Address - Fax:270-524-5891
Practice Address - Street 1:232 MAIN ST
Practice Address - Street 2:
Practice Address - City:MUNFORDVILLE
Practice Address - State:KY
Practice Address - Zip Code:42765-9043
Practice Address - Country:US
Practice Address - Phone:270-524-3669
Practice Address - Fax:270-524-5891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
KYP006673336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2028557OtherPK
KY7100187620Medicaid