Provider Demographics
NPI:1528067048
Name:CLAY, RODNEY C (PHARM DR)
Entity type:Individual
Prefix:
First Name:RODNEY
Middle Name:C
Last Name:CLAY
Suffix:
Gender:M
Credentials:PHARM DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 970
Mailing Address - Street 2:
Mailing Address - City:MAGALIA
Mailing Address - State:CA
Mailing Address - Zip Code:95954-0970
Mailing Address - Country:US
Mailing Address - Phone:530-873-0460
Mailing Address - Fax:530-873-0703
Practice Address - Street 1:14137 LAKERIDGE CIR
Practice Address - Street 2:
Practice Address - City:MAGALIA
Practice Address - State:CA
Practice Address - Zip Code:95954-9470
Practice Address - Country:US
Practice Address - Phone:530-873-0460
Practice Address - Fax:530-873-0703
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-18
Last Update Date:2007-07-08
Deactivation Date:2006-03-18
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
CARPH28030183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist