Provider Demographics
NPI:1790493377
Name:CLAYSVILLE PHARMACY LLC
Entity Type:Organization
Organization Name:CLAYSVILLE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERICH
Authorized Official - Middle Name:
Authorized Official - Last Name:CUSHEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:724-663-7707
Mailing Address - Street 1:305 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLAYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15323-3300
Mailing Address - Country:US
Mailing Address - Phone:724-663-7707
Mailing Address - Fax:724-663-5994
Practice Address - Street 1:555 ROUTE 88
Practice Address - Street 2:
Practice Address - City:CARMICHAELS
Practice Address - State:PA
Practice Address - Zip Code:15320-1173
Practice Address - Country:US
Practice Address - Phone:724-966-5237
Practice Address - Fax:724-966-9330
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLAYSVILLE PHARMACY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-11
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies