Provider Demographics
NPI:1609203058
Name:MONICAL DRUG INC
Entity Type:Organization
Organization Name:MONICAL DRUG INC
Other - Org Name:CLARK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:MONICAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-855-0922
Mailing Address - Street 1:PO BOX 207
Mailing Address - Street 2:
Mailing Address - City:CIMARRON
Mailing Address - State:KS
Mailing Address - Zip Code:67835-0207
Mailing Address - Country:US
Mailing Address - Phone:620-855-2242
Mailing Address - Fax:620-855-3616
Practice Address - Street 1:101 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CIMARRON
Practice Address - State:KS
Practice Address - Zip Code:67835-8856
Practice Address - Country:US
Practice Address - Phone:620-855-2242
Practice Address - Fax:620-855-3616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-01
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X, 3336L0003X
KS2130103336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2143009OtherPK
KS201089810AMedicaid
6980550001Medicare NSC