Provider Demographics
NPI:1134260417
Name:CLAY MEDICAL PHARMACY & MEDICAL SUPPLY, INC.
Entity type:Organization
Organization Name:CLAY MEDICAL PHARMACY & MEDICAL SUPPLY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:K C
Authorized Official - Last Name:NG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:415-956-5456
Mailing Address - Street 1:929 CLAY ST., SUITE 103
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-1556
Mailing Address - Country:US
Mailing Address - Phone:415-956-5456
Mailing Address - Fax:
Practice Address - Street 1:929 CLAY ST STE 103
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-1568
Practice Address - Country:US
Practice Address - Phone:415-956-5456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
CAPHY 30828183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA218900Medicaid
CA0721260001Medicare NSC