Provider Demographics
NPI:1437273224
Name:CLINTON AND CLINTON INC
Entity Type:Organization
Organization Name:CLINTON AND CLINTON INC
Other - Org Name:APOTHECARY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MGR
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:CLINTON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:310-737-7277
Mailing Address - Street 1:11700 NATIONAL BLVD STE L
Mailing Address - Street 2:STE L
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-3668
Mailing Address - Country:US
Mailing Address - Phone:310-737-7277
Mailing Address - Fax:310-737-7977
Practice Address - Street 1:11700 NATIONAL BLVD STE L
Practice Address - Street 2:STE L
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-3668
Practice Address - Country:US
Practice Address - Phone:310-737-7277
Practice Address - Fax:310-737-7977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-18
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
CAPHY462503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1995477OtherPK
CAPHA462500Medicaid