Provider Demographics
NPI:1407958804
Name:R & B PHARMACY INC
Entity Type:Organization
Organization Name:R & B PHARMACY INC
Other - Org Name:CLARKS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAGONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-488-2007
Mailing Address - Street 1:PO BOX 6189
Mailing Address - Street 2:
Mailing Address - City:CAREFREE
Mailing Address - State:AZ
Mailing Address - Zip Code:85377-6189
Mailing Address - Country:US
Mailing Address - Phone:480-488-2007
Mailing Address - Fax:480-575-0541
Practice Address - Street 1:36889 N TOM DARLINGTON DR
Practice Address - Street 2:STE A3
Practice Address - City:CAREFREE
Practice Address - State:AZ
Practice Address - Zip Code:85377-6189
Practice Address - Country:US
Practice Address - Phone:480-488-2007
Practice Address - Fax:480-575-0541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
AZY030343336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0318762OtherNCPDP PROVIDER IDENTIFICATION NUMBER
AZ459548Medicaid