Provider Demographics
NPI:1649683749
Name:CLEVIS MANAGEMENT CORP.
Entity type:Organization
Organization Name:CLEVIS MANAGEMENT CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:ISHIKAWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-261-5866
Mailing Address - Street 1:13181 CROSSROADS PKWY N.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CITY OF INDUSTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91746-3451
Mailing Address - Country:US
Mailing Address - Phone:323-261-5866
Mailing Address - Fax:626-739-3048
Practice Address - Street 1:1648 TYLER AVE
Practice Address - Street 2:SUITE F
Practice Address - City:S EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-3440
Practice Address - Country:US
Practice Address - Phone:626-350-1300
Practice Address - Fax:626-350-1306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-05
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy