Provider Demographics
NPI:1669651907
Name:CLARK COUNTY PHARMACY INC
Entity Type:Organization
Organization Name:CLARK COUNTY PHARMACY INC
Other - Org Name:SCOTLAND COUNTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING AGENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-465-2400
Mailing Address - Street 1:111 E MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:MO
Mailing Address - Zip Code:63555-1437
Mailing Address - Country:US
Mailing Address - Phone:660-465-2400
Mailing Address - Fax:660-465-2600
Practice Address - Street 1:111 E MONROE ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:MO
Practice Address - Zip Code:63555-1437
Practice Address - Country:US
Practice Address - Phone:660-465-2400
Practice Address - Fax:660-465-2600
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLARK COUNTY PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1301610002Medicare NSC