Provider Demographics
NPI:1598339566
Name:CLARK'S TENNESSEE PHARMACY LLC
Entity Type:Organization
Organization Name:CLARK'S TENNESSEE PHARMACY LLC
Other - Org Name:BIG COUNTRY DERMATOLOGY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CODY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:806-773-5958
Mailing Address - Street 1:1229 RESERVE BLVD STE 100A
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-3273
Mailing Address - Country:US
Mailing Address - Phone:806-451-4799
Mailing Address - Fax:
Practice Address - Street 1:1229 RESERVE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-3273
Practice Address - Country:US
Practice Address - Phone:931-487-1700
Practice Address - Fax:931-487-1720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-14
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy