Provider Demographics
NPI:1407297468
Name:VLS CLAYWORTH PHARMACY INC
Entity Type:Organization
Organization Name:VLS CLAYWORTH PHARMACY INC
Other - Org Name:CLAYWORTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUDHIR
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:510-537-9402
Mailing Address - Street 1:20353 LAKE CHABOT RD STE 101
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-5342
Mailing Address - Country:US
Mailing Address - Phone:510-537-9402
Mailing Address - Fax:510-537-1487
Practice Address - Street 1:20353 LAKE CHABOT RD STE 101
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5342
Practice Address - Country:US
Practice Address - Phone:510-537-9402
Practice Address - Fax:510-537-1487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-07
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X, 3336L0003X
CAPHY555313336L0003X
CAPHY514523336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2141316OtherPK