Provider Demographics
NPI:1417457656
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:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:CLAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-933-4762
Mailing Address - Street 1:18889 161ST AVE
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:IA
Mailing Address - Zip Code:52057-8898
Mailing Address - Country:US
Mailing Address - Phone:563-920-1135
Mailing Address - Fax:563-927-4573
Practice Address - Street 1:135 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ELKADER
Practice Address - State:IA
Practice Address - Zip Code:52043-7700
Practice Address - Country:US
Practice Address - Phone:563-245-2530
Practice Address - Fax:563-245-2537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-14
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA16333336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0222017Medicaid
2175376OtherPK