| Organization Name: | CLARKS MEDICAL CENTER PHARMACY |
| NPI Number: | 1740379080 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MALCOLM D. CLARK (PHARMACIST/MANAGER/OWNER) |
| Mailing Address: | 206 Roberts St Livingston |
| State: | TN US |
| Postal Code: | 385701506 |
| Phone Number: | 9318235534 |
| Fax Number: | 9318235534 |
| NPI Enumeration Date: | 10/12/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 302R00000X |
| License Number: | 0000001154 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Managed Care Organizations |
| Taxonomy Classification: | Health Maintenance Organization |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) A form of health insurance in which its members prepay a premium for the HMO |