Provider Demographics
NPI:1770146128
Name:CLARKSDALE PHARMACY, LLC
Entity type:Organization
Organization Name:CLARKSDALE PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:POFF
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:662-624-1011
Mailing Address - Street 1:425 DESOTO AVE
Mailing Address - Street 2:
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-5214
Mailing Address - Country:US
Mailing Address - Phone:662-627-0100
Mailing Address - Fax:662-627-0102
Practice Address - Street 1:425 DESOTO AVE
Practice Address - Street 2:
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-5214
Practice Address - Country:US
Practice Address - Phone:662-627-0100
Practice Address - Fax:662-627-0102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-20
Last Update Date:2019-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1160882OtherSTATE OF MS BUSINESS ID