Provider Demographics
NPI:1164443982
Name:CLAYSVILLE PHARMACY LLC
Entity Type:Organization
Organization Name:CLAYSVILLE PHARMACY LLC
Other - Org Name:CURTIS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERICH
Authorized Official - Middle Name:
Authorized Official - Last Name:CUSHEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:724-663-7707
Mailing Address - Street 1:802 VANDERBILT RD
Mailing Address - Street 2:
Mailing Address - City:CONNELLSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15425-6241
Mailing Address - Country:US
Mailing Address - Phone:724-626-1091
Mailing Address - Fax:724-626-0162
Practice Address - Street 1:802 VANDERBILT RD
Practice Address - Street 2:
Practice Address - City:CONNELLSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15425-6241
Practice Address - Country:US
Practice Address - Phone:724-626-1091
Practice Address - Fax:724-626-0162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP412619L332BX2000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1024774490001Medicaid
PA3942910OtherNCPDP #
PA3942910OtherNCPDP #
PAAT1292438OtherDEA #