Provider Demographics
NPI:1841321940
Name:CLARKS FAMILY PHARMACY
Entity type:Organization
Organization Name:CLARKS FAMILY PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:RILEY
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:870-792-7177
Mailing Address - Street 1:621 COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:EARLE
Mailing Address - State:AR
Mailing Address - Zip Code:72331-1616
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:621 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:EARLE
Practice Address - State:AR
Practice Address - Zip Code:72331-1616
Practice Address - Country:US
Practice Address - Phone:870-792-7177
Practice Address - Fax:870-792-9005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
ARAR193503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1988108OtherPK
AR129940407Medicaid
4288310001Medicare NSC