Provider Demographics
NPI:1528081718
Name:CLARKE-SMITH PHARMACY INC
Entity type:Organization
Organization Name:CLARKE-SMITH PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:WEATHERS
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:434-848-2340
Mailing Address - Street 1:227 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23868
Mailing Address - Country:US
Mailing Address - Phone:434-848-2340
Mailing Address - Fax:434-848-0683
Practice Address - Street 1:227 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:VA
Practice Address - Zip Code:23868
Practice Address - Country:US
Practice Address - Phone:434-848-2340
Practice Address - Fax:434-848-0683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0201001422333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8511063Medicaid
4806759OtherNABP
AC7232212OtherDEA