Provider Demographics
NPI:1841336799
Name:CLINIC PHARMACY
Entity type:Organization
Organization Name:CLINIC PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:E
Authorized Official - Last Name:EMLING
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:618-357-2871
Mailing Address - Street 1:PO BOX 364
Mailing Address - Street 2:
Mailing Address - City:PINCKNEYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62274-0364
Mailing Address - Country:US
Mailing Address - Phone:618-357-2871
Mailing Address - Fax:618-357-2174
Practice Address - Street 1:206 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:PINCKNEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62274-0364
Practice Address - Country:US
Practice Address - Phone:618-357-2871
Practice Address - Fax:618-357-2174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy