Provider Demographics
NPI:1235990276
Name:COUNTY OF CLAY
Entity Type:Organization
Organization Name:COUNTY OF CLAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:VENABLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-662-2191
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:FLORA
Mailing Address - State:IL
Mailing Address - Zip Code:62839-0280
Mailing Address - Country:US
Mailing Address - Phone:618-662-2131
Mailing Address - Fax:618-662-1482
Practice Address - Street 1:929 STACY BURK DRIVE
Practice Address - Street 2:
Practice Address - City:FLORA
Practice Address - State:IL
Practice Address - Zip Code:62839
Practice Address - Country:US
Practice Address - Phone:618-662-1600
Practice Address - Fax:618-844-8625
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF CLAY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy