Provider Demographics
NPI:1427023480
Name:C & R CLINIC PHARMACY INC. OF ELKHART
Entity Type:Organization
Organization Name:C & R CLINIC PHARMACY INC. OF ELKHART
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:620-697-2131
Mailing Address - Street 1:PO BOX 962
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:KS
Mailing Address - Zip Code:67950-0962
Mailing Address - Country:US
Mailing Address - Phone:620-697-2131
Mailing Address - Fax:620-697-4643
Practice Address - Street 1:411 SUNSET DRIVE
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:KS
Practice Address - Zip Code:67950-0962
Practice Address - Country:US
Practice Address - Phone:620-697-2131
Practice Address - Fax:620-697-4643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6590183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO93725248Medicaid
OK100245910AMedicaid
KS100438580AMedicaid
1710640OtherNCPDP PHARMACY NUMBER
KS0202520001Medicare NSC