Provider Demographics
NPI:1649027434
Name:CLIO COMMUNITY PHARMACY INC
Entity type:Organization
Organization Name:CLIO COMMUNITY PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:FOSKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-547-7201
Mailing Address - Street 1:4180 W VIENNA RD STE 4
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420-9497
Mailing Address - Country:US
Mailing Address - Phone:810-547-7201
Mailing Address - Fax:810-309-9075
Practice Address - Street 1:4180 W VIENNA RD STE 4
Practice Address - Street 2:
Practice Address - City:CLIO
Practice Address - State:MI
Practice Address - Zip Code:48420-9497
Practice Address - Country:US
Practice Address - Phone:810-547-7201
Practice Address - Fax:810-309-9075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy