Provider Demographics
NPI:1083985923
Name:CLAYTON PHARMACY SERVICES
Entity Type:Organization
Organization Name:CLAYTON PHARMACY SERVICES
Other - Org Name:CLAYTON DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER/SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-939-2569
Mailing Address - Street 1:104 W MISSION ST
Mailing Address - Street 2:
Mailing Address - City:STRAWBERRY POINT
Mailing Address - State:IA
Mailing Address - Zip Code:52076-4400
Mailing Address - Country:US
Mailing Address - Phone:563-933-4762
Mailing Address - Fax:563-933-9909
Practice Address - Street 1:104 W MISSION ST
Practice Address - Street 2:
Practice Address - City:STRAWBERRY POINT
Practice Address - State:IA
Practice Address - Zip Code:52076-4400
Practice Address - Country:US
Practice Address - Phone:563-933-4762
Practice Address - Fax:563-933-9909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-24
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X, 3336L0003X
IA68333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2133582OtherPK
IA6685480002Medicare NSC